title: Primary liver cancer is more aggressive in HIV-HCV coinfection than in HCV infection. A prospective study (ANRS CO13 Hepavih and CO12 Cirvir).
abstract: OBJECTIVE
  Since HAART, primary liver cancer has emerged as an increasing cause of morbidity and mortality in patients with HIV infection. Our aim was to compare characteristics and outcome of primary liver cancer according to HIV status in HCV cirrhotic patients submitted to periodic ultrasonographic surveillance.
  
  
  METHODS
  All patients with primary liver cancer and cirrhosis were selected from two prospective cohorts (ANRS CO12 Cirvir, viral cirrhosis, n=1081; ANRS CO13 Hepavih, HIV-HCV coinfection, n=1175). Cirrhosis was diagnosed by liver biopsy in monoHCV group and biopsy and/or non-invasive tests in HIV-HCV group. Ultrasonographic surveillance was performed every 6 months. Diagnosis of primary liver cancer was established according to EASL-AASLD guidelines.
  
  
  RESULTS
  Primary liver cancer was diagnosed in 32 patients, 16 in each group, and corresponded to hepatocellular carcinoma in all except for two cholangiocarcinomas in HIV-HCV patients. Ultrasonographic follow-up was similar (median time since last ultrasonographic without focal lesion: 237 days in HIV-HCV group (n=12) versus 208 days in HCV group, NS). At primary liver cancer diagnosis HIV-HCV patients were markedly younger (48 vs. 60 yrs, P<0.001), primary liver cancer was more advanced in HIV-HCV patients (single nodule: 43% vs. 75%, P=0.07; mean diameter of main nodule: 24 vs. 16 mm, P=0.006; portal obstruction: 3 vs. 0). Curative treatment was performed in four HIV-HCV patients versus 11 HCV patients (P=0.017). During follow-up, 10 HIV-HCV patients died versus only one HCV patient (P=0.0005).
  
  
  CONCLUSIONS
  This result suggests more aggressiveness for tumors in HIV infected patients and, if confirmed, could result in shortening the length between ultrasonographic examinations.
authors.affiliation: Service d'hépato-gastroentérologie, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, UFR SMBH, université Paris-13, 93143 Bondy cedex, France. valerie.bourcier@jvr.aphp.fr
authors.forename: Valérie
authors.initials: V
authors.lastname: Bourcier
authors.forename: Maria
authors.initials: M
authors.lastname: Winnock
authors.forename: Mohand
authors.initials: M
authors.lastname: Ait Ahmed
authors.forename: Philippe
authors.initials: P
authors.lastname: Sogni
authors.forename: Elodie
authors.initials: E
authors.lastname: Pambrun
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
authors.forename: Cendrine
authors.initials: C
authors.lastname: Chaffaut
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D011446:Prospective Studies; D012039:Regional Blood Flow; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins