Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.
aAP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire
cInserm U785, Villejuif
dUniversité Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre
eAP-HP Hôpital Paul Brousse, Département Virologie, Villejuif
fAP-HP Hôpital Bicêtre, Service de Médecine Interne, Immunologie Clinique et Maladies Infectieuses, Le Kremlin-Bicêtre
gAP-HP Hôpital Cochin, Unité d’Hépatologie et Université Paris Descartes, Inserm U1016
hAP-HP Hôpital Cochin, Service des Maladies Infectieuses et Tropicales et Université Paris Descartes, Paris
iAP-HP Hôpital Bicêtre, Service d’Epidémiologie et de Santé Publique et Université Paris-Sud, Inserm U1018, Le Kremlin-Bicêtre
jAP-HP Hôpital Jean Verdier, Service d’Hépato-Gastro-Entérologie et Université Paris 13, Inserm UMR 1162, Bondy
kAP-HP Hôpital Paul Brousse, Service de Radiologie, Villejuif
lCHU de Pointe-à-Pitre, Service d’Hépato-Gastro-Entérologie, Pointe-à-Pitre, Guadeloupe, France.
Correspondence to Dr Moana Gelu-Simeon, Centre Hepato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France. Tel: +33 1 45 59 67 99; fax: +33 1 45 59 67 91; e-mail: firstname.lastname@example.org
Received 14 January, 2014
Revised 2 April, 2014
Accepted 3 April, 2014