Primary liver cancer is more aggressive in HIV-HCV coinfection than in HCV infection. A prospective study (ANRS CO13 Hepavih and CO12 Cirvir)

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• 作者：Val&eacute ; rie Bourcier^a ; ^{valerie.bourcier@jvr.aphp.fr} ; Maria Winnock^b ; Mohand Ait Ahmed^c ; Philippe Sogni^c ; Elodie Pambrun^b ; Isabelle Poizot-Martin^d ; Cendrine Chaffaut^e ; Sylvie Chevret^e ; Jean-Claude Trinchet^a ; Dominique Salmon^f ; for the ANRS CO13 Hepavih ; ANRS CO12 Cirvir study groups
• 关键词：AFP ; Alphafetoprotein ; HAART ; Highly active antiretroviral therapy ; HCC ; Hepatocellular carcinoma ; HCV ; hepatitis C virus ; US ; ultrasonography ; CC ; cholangiocarcinoma
• 刊名：Clinics and Research in Hepatology and Gastroenterology
• 出版年：2012
• 期刊代码：pca104_22107401
• 类别：med
• 出版时间：June, 2012
• 卷：36
• 期：3
• 页码：214-221
• 文件大小：407 K

摘要

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class="h3">Summary

class="h4">Objective

Since HAART, primary liver cancer has emerged as an increasing cause of morbidity and mortality in patients with HIV infection. Our aim was to compare characteristics and outcome of primary liver cancer according to HIV status in HCV cirrhotic patients submitted to periodic ultrasonographic surveillance.

class="h4">Methods

All patients with primary liver cancer and cirrhosis were selected from two prospective cohorts (ANRS CO12 Cirvir, viral cirrhosis, n = 1081; ANRS CO13 Hepavih, HIV-HCV coinfection, n = 1175). Cirrhosis was diagnosed by liver biopsy in monoHCV group and biopsy and/or non-invasive tests in HIV-HCV group. Ultrasonographic surveillance was performed every 6 months. Diagnosis of primary liver cancer was established according to EASL-AASLD guidelines.

class="h4">Results

Primary liver cancer was diagnosed in 32 patients, 16 in each group, and corresponded to hepatocellular carcinoma in all except for two cholangiocarcinomas in HIV-HCV patients. Ultrasonographic follow-up was similar (median time since last ultrasonographic without focal lesion: 237 days in HIV-HCV group (n = 12) versus 208 days in HCV group, NS). At primary liver cancer diagnosis HIV-HCV patients were markedly younger (48 vs. 60 yrs, P < 0.001), primary liver cancer was more advanced in HIV-HCV patients (single nodule: 43%vs. 75%, P = 0.07; mean diameter of main nodule: 24 vs. 16 mm, P = 0.006; portal obstruction: 3 vs. 0). Curative treatment was performed in four HIV-HCV patients versus 11 HCV patients (P = 0.017). During follow-up, 10 HIV-HCV patients died versus only one HCV patient (P = 0.0005).

class="h4">Conclusions

This result suggests more aggressiveness for tumors in HIV infected patients and, if confirmed, could result in shortening the length between ultrasonographic examinations.