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

Autor: Miguel Rodríguez-Fernández, Ignacio Santos, Miguel Ángel López-Ruz, Juan A. Pineda, Joseba Portu, Mohamed Omar, Marta Montero, Francisco Rodríguez-Arrondo, Marcial Delgado-Fernández, Koldo Aguirrebengoa, María A. García, Miguel García-Deltoro, Juan Macías, Antonio Rivero-Juárez, Francisco Jesús Vera-Méndez, Esperanza Merino, María José Galindo, Carlos Galera, Blanca Figueruela, Marina Villalobos, Nicolás Merchante, María J. Ríos-Villegas, Boris Revollo, Carlos Mínguez, Sofía Ibarra, Francisco Téllez
Přispěvatelé: Junta de Andalucía, European Commission, Instituto de Salud Carlos III
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Aids
r-FIHGUV. Repositorio Institucional de Producción Científica de la Fundación de Investigación del Hospital General de Valencia
instname
AIDS
r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol
Digital.CSIC. Repositorio Institucional del CSIC
r-FISABIO. Repositorio Institucional de Producción Científica
ISSN: 0269-9370
Popis: On behalf of the GEHEP-002 Study Group.
[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.
The current study was supported by grants from the Consejería de Salud de la Junta de Andalucía (PI-0014/2014), the Servicio Andaluz de Salud (grant number SAS/111239) and the Fondo de Investigaciones Sanitarias ISCIII (grant number PI13/01621) and Project ‘PI16/01443’, funded by Instituto de Salud Carlos III, integrated in the national I+D+i 2013–2016 and co-funded by European Union (ERDF/ESF, ‘Investing in your future’). J.A.P. is the recipient of an intensification grant from the Instituto de Salud Carlos III (grant number Programa-I3SNS). Besides, this work has been partially funded by the Grupo para el Estudio de las Hepatitis Víricas (GEHEP) de la SEIMC (2017 grant to project GEHEP-002 and 2018 grant to project GEHEP-002), the SPANISH AIDS Research Network RD16/0025/0010 as part of the Plan Nacional R+D+I and cofinanced by ISCIII Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER).
Databáze: OpenAIRE
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