Screening for hepatocellular carcinoma (HCC) in hepatitis/HIV co-infection using ultrasound imaging and alfa-feto protein levels
Lo, G., Herrmann, S., Cheng, W., Kontorinis, N., Phillips, E., Nolan, D. and Lucas, M. (2008) Screening for hepatocellular carcinoma (HCC) in hepatitis/HIV co-infection using ultrasound imaging and alfa-feto protein levels. In: 20th Annual Australasian Society for HIV Medicine Conference, 17 - 20 September, Perth, Western Australia.
Hepatocellular carcinoma (HCC) is a serious complication of chronic viral hepatitis once cirrhosis has developed. Screening for HCC allows for early detection in HCV or HBV mono-infection and, if detected, possible treatment. Since HIV co-infection is associated with faster progression of liver disease in both HBV and HCV infection and non-AIDS cancers have recently been shown to be more common and occur earlier in the setting of HIV, it is likely that HIV co-infection increases not only the rapidity of hepatocarcinogenesis but also the overall risk of HCC. Screening for HCC by abdominal ultrasound and alfafeto protein (AFP) measurement is recommended at 6 to 12 month intervals for both HBV and HCV monoinfected patients. There are multiple treatment modalities currently available for HCC including radio-frequency ablation, percutaneous ethanol injection, trans-arterial chemo-embolisation, resection and liver transplantation. Treatment is a feasible option in those individuals with hepatitis/HIV co-infection who are successfully treated with HAART and otherwise healthy.
Fifty-one hepatitis/HIV co-infected patients attending the Ambulatory HIV Service at Royal Perth Hospital (RPH) were identified and their medical records reviewed to identify uptake of HCC screening. Since 2000, 21 patients (41%) were screened at least once by abdominal ultrasound, 5 more had ultrasound requested for other reasons (e.g. renal failure). One patient was subsequently found to have a HCC as an incidental finding. Nine of the 21 patients (42%) screened since 2000 have had a second study performed and 8 more patients (31%) are awaiting further follow-up. The mean interval between ultrasound screenings was 1.0 year (range 0.5-2.2). Thirty patients (59%) have been screened for HCC with measurement of serum AFP.
There has been poor uptake of initial and follow-up HCC screening with abdominal ultrasound and AFP in hepatitis/HIV co-infected patients at RPH and few patients have had regular follow-up scans. Improved drug treatments have resulted in decreased mortality from HIV in countries with access to HAART but co-infection with hepatitis poses a significant threat to those that might otherwise expect a normal lifespan. Improved screening protocols for HCC are warranted.
|Publication Type:||Conference Item|
|Murdoch Affiliation:||Centre for Clinical Immunology and Biomedical Statistics|
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