Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2018; 24(5): 613-622
Published online Feb 7, 2018. doi: 10.3748/wjg.v24.i5.613
Incidence of hepatocellular carcinoma in patients with chronic liver disease due to hepatitis B or C and coinfected with the human immunodeficiency virus: A retrospective cohort study
Patrícia dos Santos Marcon, Cristiane Valle Tovo, Dimas Alexandre Kliemann, Patrícia Fisch, Angelo Alves de Mattos
Patrícia dos Santos Marcon, Cristiane Valle Tovo, Angelo Alves de Mattos, Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90020-090, RS, Brazil
Dimas Alexandre Kliemann, Infectology Department at Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, RS, Brazil
Patrícia Fisch, Epidemiology Department at Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, RS, Brazil
Author contributions: All authors have been involved since the creation of the project of the present study until obtaining the data and writing this text; the present study presents the opinion of all authors.
Institutional review board statement: The study was reviewed and approved by the Universidade Federal de Ciências da Saúde de Porto Alegre Institutional Review Board.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported. No founding sources to declare.
Data sharing statement: All available data can be obtained by contacting the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Patrícia dos Santos Marcon, MD, Doctor, Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Professor Annes Dias, 135, 7º floor, Porto Alegre 90020-090, RS, Brazil. patekapel@hotmail.com
Telephone: +55-51-32148158 Fax: +55-51-33038795
Received: November 29, 2017
Peer-review started: November 29, 2017
First decision: December 20, 2017
Revised: December 26, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: February 7, 2018
Processing time: 63 Days and 0.6 Hours
Abstract
AIM

To assess the incidence of hepatocellular carcinoma (HCC) in chronic liver disease due to hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfected with human immunodeficiency virus (HIV).

METHODS

A retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.

RESULTS

Of 804 patients were included (399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger (36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected (P < 0.001). HCC was diagnosed in 36 patients (10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years (95%CI: 0.12-0.46 vs 0.47-1.05) (long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC.

CONCLUSION

In this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.

Keywords: Hepatocellular carcinoma; Chronic hepatitis; Human immunodeficiency virus; Coinfection; Cirrhosis

Core tip: We conducted a retrospective cohort study with 804 patients with chronic viral hepatitis B or C, with and without human immunodeficiency virus (HIV) coinfection (399 HIV-coinfected and 405 monoinfected with HBV or HCV). The main objective was to assess the incidence of hepatocellular carcinoma in HIV-coinfected patients. Hepatocellular carcinoma (HCC) was observed in 36 patients (10 HIV-positive and 26 HIV-negative). When adjusted for age, the role of HIV was no longer statistical significant for the development of HCC. Moreover, when analyzing cirrhotic patients only, the HCC incidence had no difference between the groups. Only age and alcohol use were associated with risk of developing HCC.