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HIV/hepatitis C virus-coinfected patients who achieved sustained virological response are still at risk of developing hepatocellular carcinoma

Merchante, Nicolása,n; Merino, Esperanzab,o; Rodríguez-Arrondo, Franciscoc,p; Tural, Cristinad; Muñoz, Josefae,p; Delgado-Fernández, Marcialf,n; Jover, Franciscog,o; Galindo, Maria J.h,o; Rivero, Antonioi,n; López-Aldeguer, Joséj,o; Aguirrebengoa, Koldok,p; Romero-Palacios, Albertol,n; Martínez, Eduardom,p; Pineda, Juan A.a,n

doi: 10.1097/QAD.0000000000000005
Clinical Science

Objective: To describe the frequency and the characteristics of hepatocellular carcinoma (HCC) cases that appeared in HIV/hepatitis C virus (HCV)-coinfected patients with previous sustained virological response (SVR) and to compare these cases to those diagnosed in patients without SVR.

Methods: All HIV/HCV-coinfected patients diagnosed with HCC in 26 hospitals in Spain before 31 December 2012 were analyzed. Comparisons between cases diagnosed in patients with and without previous SVR were made.

Results: One hundred and sixty-seven HIV/HCV-coinfected patients were diagnosed with HCC in the participant hospitals. Sixty-five (39%) of them had been previously treated against HCV. In 13 cases, HCC was diagnosed after achieving consecution of SVR, accounting for 7.8% of the overall cases. The median (Q1–Q3) elapsed time from SVR to diagnosis of HCC was 28 (20–39) months. HCC was multicentric and was complicated with portal thrombosis in nine and six patients, respectively. Comparisons with HCC cases diagnosed in patients without previous SVR only yielded a significantly higher proportion of genotype 3 infection [10 (83%) out of 13 cases versus 34 (32%) out of 107; P = 0.001)]. The median (Q1–Q3) survival of HCC was 3 (1–39) months among cases developed in patients with previous SVR, whereas it was 6 (2–20) months in the remaining individuals (P = 0.7).

Conclusion: HIV/HCV-coinfected patients with previous SVR may develop HCC in the mid term and long term. These cases account for a significant proportion of the total cases of HCC in this setting. Our findings reinforce the need to continue surveillance of HCC with ultrasound examinations in patients with cirrhosis who respond to anti-HCV therapy.

aUnidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla

bUnidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante

cUnidad de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Guipúzcoa

dHIV Clinical Unit and Fundació de la LLuita contra la Sida, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona

eUnidad de Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Vizcaya

fServicio de Enfermedades Infecciosas, Hospital Regional Carlos Haya, Málaga

gUnidad de Enfermedades Infecciosas, Hospital Clínico Universitario de San Juan, Alicante

hUnidad de Enfermedades Infecciosas, Hospital Clínico de Valencia, Valencia

iUnidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba

jUnidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe, Valencia

kUnidad de Enfermedades Infecciosas, Hospital de Cruces, Bilbao, Vizcaya

lUnidad de Enfermedades Infecciosas, Hospital Universitario de Puerto Real, Cádiz

mUnidad de Enfermedades Infecciosas, Hospital de Galdakao, Vizcaya

nGrupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)

oSociedad Enfermedades Infecciosas de la Comunidad Valenciana (SEICV)

pSociedad de Enfermedades Infecciosas del Norte (SEINORTE), Spain.

Correspondence to Juan A. Pineda, Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Avenida de Bellavista, s/n. 41014 Sevilla, Spain. Tel: +34 955015684/34 955015757; fax: +34 955015887; e-mail: japineda@telefonica.net

Received 27 April, 2013

Revised 10 July, 2013

Accepted 11 July, 2013

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© 2014 Lippincott Williams & Wilkins, Inc.