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Low performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma in HIV-infected patients

AuthorsMerchante, Nicolás; Figueruela, Blanca; Rodríguez-Fernández, Miguel; Rodríguez-Arrondo, Francisco; Revollo, Boris; Ibarra, Sofía; Galindo, María José; Merino, Esperanza; Montero, Marta; Téllez, Francisco; García-Deltoro, Miguel; Rivero-Juárez, Antonio; Delgado-Fernández, Marcial; Ríos-Villegas, María José; Aguirrebengoa, Koldo; García, María A.; Portu, Joseba; Vera-Méndez, Francisco Jesús; Villalobos, Marina; Mínguez, Carlos; De Los Santos, Ignacio; López-Ruz, Miguel A.; Omar, Mohamed; Galera, Carlos; Macias, Juan; Pineda, Juan A.
Issue Date2019
PublisherLippincott Williams & Wilkins
CitationAIDS 33(2): 269-278 (2019)
Abstract[Objective]: To assess the performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma (HCC) in HIV-infected patients.
[Methods]: The GEHEP-002 cohort recruits HCC cases diagnosed in HIV-infected patients from 32 centers across Spain. The proportion of ‘ultrasound lack of detection’, defined as HCC diagnosed within the first 3 months after a normal surveillance ultrasound, and the proportion of ‘surveillance failure’, defined as cases in which surveillance failed to detect HCC at early stage, were assessed. To assess the impact of HIV, a control population of 104 HCC cases diagnosed in hepatitis C virus-monoinfected patients during the study period was used.
[Results]: A total of 186 (54%) out of 346 HCC cases in HIV-infected patients were diagnosed within an ultrasound surveillance program. Ultrasound lack of detection occurred in 16 (8.6%) of them. Ultrasound surveillance failure occurred in 107 (57%) out of 186 cases diagnosed by screening, whereas this occurred in 18 (29%) out of 62 diagnosed in the control group (P < 0.0001). HCC cases after ultrasound surveillance failure showed a lower frequency of undetectable HIV viral load at diagnosis. The probability of 1-year and 2-year survival after HCC diagnosis among those diagnosed by screening was 56 and 45% in HIV-infected patients, whereas it was 79 and 64% in HIV-negative patients (P = 0.038).
[Conclusion]: The performance of ultrasound surveillance of HCC in HIV-infected patients is very poor and worse than that shown outside HIV infection. A HCC surveillance policy based on ultrasound examinations every 6 months might be insufficient in HIV-infected patients with cirrhosis.
DescriptionOn behalf of the GEHEP-002 Study Group.
Publisher version (URL)https://doi.org/10.1097/QAD.0000000000002065
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