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Lui GCY, Hui VWK, Sze SF, Wong BCK, Cheung C, Lee MP, Yip TCF, Tse YK, Lai JCT, Chan HLY, Wong VWS, Hui YT, Wong GLH. Incidence of hepatocellular carcinoma and mortality in chronic viral hepatitis in an Asian population with and without HIV infection. Aliment Pharmacol Ther 2023; 58:814-823. [PMID: 37515399 DOI: 10.1111/apt.17654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND It is uncertain whether people with HIV infection have a higher incidence of hepatocellular carcinoma (HCC) than the general population. AIMS To compare the incidence of HCC between people infected with HBV and/or HCV with and without HIV METHODS: We performed a retrospective population-based cohort study, involving people with HBV and/or HCV infection from 2001 to 2018. The primary endpoint was incidence of HCC; secondary endpoint was all-cause mortality. We performed Cox proportional hazard regression models to estimate the hazard ratios (HR) of HIV for the primary and secondary endpoints. RESULTS We identified 1374 people infected with HIV and 39,908 people without HIV with HBV and/or HCV infection. Among those with HIV, 654 (47.6%) had HBV, 649 (47.2%) HCV and 71 (5.2%) HBV-HCV-co-infection; they were younger, and had a higher prevalence of HCV and a lower prevalence of cirrhosis. The incidence rate estimates of HCC were, respectively, 1.5 (95% CI: 0.8-2.5) and 7.6 (95% CI 7.3-8.0) per 1000 person-years for those with and without HIV infection. Using multivariate Cox proportional hazard regression models, among people with HBV, HIV was associated with lower risk of HCC (adjusted HR: 0.376, 95% CI: 0.201-0.704, p = 0.01) and death (adjusted HR: 0.692, 95% CI: 0.552-0.867, p = 0.007). Risks of HCC were similar for HCV and HBV-HCV co-infection for people with and without HIV. CONCLUSIONS Among individuals with HBV infection, the Incidence of HCC was lower in those with HIV. For HCV infection, incidence of HCC was similar between those with and without HIV.
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Affiliation(s)
- Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Vicki Wing-Ki Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Shun-Fung Sze
- Queen Elizabeth Hospital, Hong Kong, Special Administrative Region, China
| | - Bonnie Chun-Kwan Wong
- Integrated Treatment Centre, Department of Health, Hong Kong, Special Administrative Region, China
| | - Catherine Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Man-Po Lee
- Queen Elizabeth Hospital, Hong Kong, Special Administrative Region, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Jimmy Che-To Lai
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Henry Lik-Yuen Chan
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Union Hospital, Hong Kong, Special Administrative Region, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Yee-Tak Hui
- Queen Elizabeth Hospital, Hong Kong, Special Administrative Region, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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Kim NJ, Vutien P, Cleveland E, Cravero A, Ioannou GN. Fibrosis Stage-specific Incidence of Hepatocellular Cancer After Hepatitis C Cure With Direct-acting Antivirals: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00438-4. [PMID: 35525392 PMCID: PMC9636072 DOI: 10.1016/j.cgh.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) eradication with direct-acting antivirals reduces hepatocellular carcinoma (HCC) risk. Pooled HCC incidence rates by cirrhosis status and fibrosis stage have not been estimated using meta-analysis. METHODS We searched PubMed, Web of Science, Embase, and Cochrane Library from January 1, 2014 to December 31, 2020 to identify studies assessing HCC incidence or outcomes by cirrhosis status, in adults with HCV who achieved sustained virologic response (SVR) after direct-acting antivirals. Pooled estimates were obtained using random-effects modeling. Subgroup, sensitivity, and meta-regression analyses were performed to evaluate heterogeneity. RESULTS We included 31 studies involving 27,711 patients with cirrhosis (mean follow-up, 2.1 years) and 11 studies involving 32,123 patients without cirrhosis (mean follow-up, 2.6 years). HCC incidence was 2.99/100 person-years (95% confidence interval [CI], 2.52-3.54; I2 = 75%) in patients with cirrhosis, 0.47/100 person-years (95% CI, 0.32-0.70, I2 = 71%) in patients without cirrhosis, and 0.63/100 person-years (95% CI: 0.34-1.20, I2 = 0%) in stage 3 (F3) fibrosis. Among patients with cirrhosis, HCC incidence was highest in studies with <1 year of follow-up (6.17/100 person-years [95% CI, 3.73-10.19]) and progressively lower in studies with longer follow-up (1-2 years: 2.75/100 person-years [95% CI, 2.48-3.06]; 2-3 years: 2.90/100 person-years [95% CI, 1.90-4.44]; ≥3 years: 1.83/100 person-years [95% CI, 0.88-3.80]). CONCLUSION Pooled HCC incidence after SVR in patients with cirrhosis was very high (2.99/100 person-years) but may be declining as longer time accrues after SVR. In patients without cirrhosis, including F3 fibrosis, HCC incidence was lower than thresholds associated with cost-effective HCC screening. In patients with F3 fibrosis, the lack of between-study heterogeneity provides strong evidence that HCC screening may not be warranted.
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Affiliation(s)
- Nicole J. Kim
- Division of Gastroenterology, University of Washington
| | - Philip Vutien
- Division of Gastroenterology, University of Washington
| | | | - Anne Cravero
- Department of Medicine, University of Washington
| | - George N. Ioannou
- Division of Gastroenterology, University of Washington,Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System
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DiMaio D, Emu B, Goodman AL, Mothes W, Justice A. Cancer Microbiology. J Natl Cancer Inst 2021; 114:651-663. [PMID: 34850062 DOI: 10.1093/jnci/djab212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/18/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
Microbes play important roles in cancer from direct carcinogenic effects to their use in treatment. Cancers caused by microorganisms account for approximately 15% of cancers, mostly in low- and middle-income countries. Unique features of infectious carcinogens include their transmissibility, mutability, and specific immune interactions, which provide challenges and opportunities for cancer prevention and treatment. For these agents, infection control through exposure reduction, antivirals, antibiotics, and vaccines is cancer control. In addition, developing evidence suggests that microorganisms including the human microbiome can indirectly modulate cancer formation and influence the effectiveness and toxicity of cancer treatments. Finally, microorganisms themselves can be used to prevent or treat cancer. The convergence of these factors signals the emergence of a new field, Cancer Microbiology. Recognition of Cancer Microbiology will spur research, stimulate cross-disciplinary training, inform drug development, and improve public health.
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Affiliation(s)
- Daniel DiMaio
- Department of Genetics, Yale School of Medicine, New Haven, P.O. Box 208005, CT, USA, 06520-8005.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, P.O. Box 208040, CT, USA, 06520-8040.,Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, P.O. Box 208024, CT, USA, 06520-8024.,Yale Cancer Center, New Haven, P.O. Box 208028, CT, USA, 06520-8028
| | - Brinda Emu
- Yale Cancer Center, New Haven, P.O. Box 208028, CT, USA, 06520-8028.,Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, P.O. Box 208022, CT, 06520-8022
| | - Andrew L Goodman
- Yale Cancer Center, New Haven, P.O. Box 208028, CT, USA, 06520-8028.,Department of Microbial Pathogenesis, Yale University, New Haven, P.O. Box 9812, CT, USA, 06536-0812
| | - Walther Mothes
- Yale Cancer Center, New Haven, P.O. Box 208028, CT, USA, 06520-8028.,Department of Microbial Pathogenesis, Yale University, New Haven, P.O. Box 9812, CT, USA, 06536-0812
| | - Amy Justice
- Yale Cancer Center, New Haven, P.O. Box 208028, CT, USA, 06520-8028.,Department of General Medicine, Yale University, VA Medical Center, New Haven, 06516, CT, USA
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Corma-Gómez A, Macías J, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Santos M, Real LM, Palacios R, Santos IDL, Geijo P, Imaz A, Merino D, Galindo MJ, Reus-Bañuls S, López-Ruz MÁ, Galera C, Pineda JA. Kinetics of emergence of liver complications in hepatitis C virus infected patients and advanced fibrosis, with and without HIV-coinfection, after sustained virological response. AIDS 2021; 35:2119-2127. [PMID: 34049354 DOI: 10.1097/qad.0000000000002959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN A multicentric prospective cohort study. METHODS HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz
| | - Luis Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba
| | - Miriam Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla
| | - Francisco Jesús Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena
| | - Marta Santos
- Unit of Internal Medicine, Hospital Universitario del SAS de Jerez, Cadiz
| | - Luis Miguel Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga
| | | | - Paloma Geijo
- Unit of Infectious Diseases, Hospital Virgen de la Luz, Cuenca
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva
| | - Maria José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Alicante
| | | | - Carlos Galera
- Unit of Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
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Corma-Gómez A, Macías J, Rivero A, Rivero-Juarez A, de los Santos I, Reus-Bañuls S, Morano L, Merino D, Palacios R, Galera C, Fernández-Fuertes M, González-Serna A, de Rojas I, Ruiz A, Sáez ME, Real LM, Pineda JA. A Genome-Wide Association Study on Liver Stiffness Changes during Hepatitis C Virus Infection Cure. Diagnostics (Basel) 2021; 11:1501. [PMID: 34441435 PMCID: PMC8394459 DOI: 10.3390/diagnostics11081501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
Liver stiffness (LS) at sustained virological response (SVR) after direct-acting antivirals (DAA)-based therapy is a predictor of liver events in hepatitis C virus (HCV)-infected patients. The study aim was to identify genetic factors associated with LS changes from the moment of starting anti-HCV therapy to SVR. This prospective study included HCV-infected patients from the GEHEP-011 cohort who achieved SVR with DAA-based therapy, with LS pre-treatment ≥ 9.5 kPa and LS measurement available at SVR. Plink and Magma software were used to carry out genome-wide single-nucleotide polymorphism (SNP)-based and gene-based association analyses, respectively. The ShinyGO application was used for exploring enrichment in Gene Ontology (GO) categories for biological processes. Overall, 242 patients were included. Median (quartile 1, quartile 3) LS values at pre-treatment and at SVR were 16.8 (12, 28) kPa and 12.0 (8.5, 19.3) kPa, respectively. Thirty-five SNPs and three genes reached suggestive association with LS changes from the moment of starting anti-HCV therapy to SVR. GO categories related to DNA packaging complex, DNA conformation change, chromosome organization and chromatin organization were significantly enriched. Our study reports possible genetic factors associated with LS changes during HCV-infection cure. In addition, our results suggest that processes related to DNA conformation are also involved in these changes.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (A.R.); (A.R.-J.)
| | - Antonio Rivero-Juarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (A.R.); (A.R.-J.)
| | - Ignacio de los Santos
- Unidad de Medicina Interna y Enfermedades Infecciosas, Hospital de La Princesa, 28006 Madrid, Spain;
| | - Sergio Reus-Bañuls
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Luis Morano
- Unidad de Patología Infecciosa, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), 36312 Vigo, Spain;
| | - Dolores Merino
- Unidad de Enfermedades Infecciosas, Hospital Universitario Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, 29010 Málaga, Spain;
| | - Carlos Galera
- Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Marta Fernández-Fuertes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Alejandro González-Serna
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Itziar de Rojas
- Fundació ACE—Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain; (I.d.R.); (A.R.)
- CIBERNED Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Agustín Ruiz
- Fundació ACE—Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain; (I.d.R.); (A.R.)
- CIBERNED Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María E. Sáez
- Centro Andaluz de Estudios Bioinformáticos (CAEBI, SL), 41013 Sevilla, Spain;
| | - Luis M. Real
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Universidad de Málaga, 29010 Málaga, Spain
| | - Juan A. Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
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Saldarriaga OA, Dye B, Pham J, Wanninger TG, Millian D, Kueht M, Freiberg B, Utay N, Stevenson HL. Comparison of liver biopsies before and after direct-acting antiviral therapy for hepatitis C and correlation with clinical outcome. Sci Rep 2021; 11:14506. [PMID: 34267267 PMCID: PMC8282660 DOI: 10.1038/s41598-021-93881-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023] Open
Abstract
Direct-acting antivirals (DAA) have replaced interferon (IFN)-based therapies for hepatitis C virus. In this retrospective clinical study, we examined differences in histopathologic features in paired liver biopsies collected from the same patient before and after DAA and correlated these findings with clinical outcome. Biopsies (n = 19) were evaluated by quantitative imaging analysis to measure steatosis and fibrosis. Most patients had decreased steatosis in their post-treatment, follow-up biopsies. However, one patient had a striking increase in steatosis (from 0.86 to 6.32%) and later developed decompensated cirrhosis and hepatocellular carcinoma (HCC). This patient had a marked increase in fibrosis between biopsies, with a CPA of 6.74 to 32.02. Another patient, who already had bridging fibrosis at the time of her pre-treatment biopsy, developed cholangiocarcinoma after DAA. Even though the overall inflammatory activity in the post-treatment biopsies significantly decreased after treatment, 60% of patients had persistent portal lymphocytic inflammation. In summary, DAAs decreased steatosis and hepatic inflammation in most patients, although some may have persistence of lymphocytic portal inflammation. Patients known to have advanced fibrosis at treatment initiation and who have other risk factors for ongoing liver injury, such as steatosis, should be followed closely for the development of adverse outcomes, such as portal hypertension and primary liver cancers.
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Affiliation(s)
- Omar A Saldarriaga
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Bradley Dye
- School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Judy Pham
- School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Timothy G Wanninger
- School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Daniel Millian
- School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Michael Kueht
- Dept. of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA
| | - Benjamin Freiberg
- Digital Pathology, Araceli Biosciences, 7425 NE Evergreen Pkwy, Hillsboro, OR, 97124, USA
| | - Netanya Utay
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 7000 Fannin St # 1200, Houston, TX, 77030, USA
| | - Heather L Stevenson
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA.
- Department of Pathology, The University of Texas Medical Branch, 712 Texas Avenue, Clinical Services Wing-Room 5.506Q, Galveston, TX, 77555-0416, USA.
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7
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Modifications of liver stiffness and CXCL4, TGF-β1 and HGF are similar in HCV- and HIV/HCV-infected patients after DAAs. Sci Rep 2021; 11:9824. [PMID: 33972651 PMCID: PMC8110591 DOI: 10.1038/s41598-021-89370-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023] Open
Abstract
The objective of this work was to identify predictive factors of fibrosis regression after direct antiviral agents (DAAs) in HCV-monoinfected and HIV/HCV-coinfected patients. This was a prospective study of HCV-monoinfected (n = 20), HIV/HCV-co-infected (n = 66) patients and healthy controls (n = 15). Patients had started DAAs and achieved sustained virological response. Liver stiffness (LS) and serum concentrations of profibrotic transforming growth factor (TGF)-β1 and CXC chemokine ligand 4 (CXCL4) and antifibrotic HGF hepatocyte growth factor (HGF) were analyzed at baseline (M0) and 12 months after starting DAAs (M12). A M12 LS achievement of ≤ 9.5 kPa was considered the cutoff point to discharge from a liver clinic. The LS decrease from M0 to M12 was 34%. No significant differences were observed in LS decline between HCV- and HIV/HCV-infected individuals. Changes of serum CXCL4, TGF-β1 and HGF levels did not correlate with LS improvement. 16 out from 56 patients (28%) with a baseline LS > 9.5 achieved a M12 LS ≤ 9.5. HCV-monoinfected and HIV/HCV coinfected patients experienced a significant reduction of LS after sustained virological response. This improvement did not correlate with changes in serum profibrotic or antifibrotic markers. A 29% of those with a baseline LS > 9.5 achieved a LS under this cutoff point.
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Basso M, Zago D, Scaggiante R, Cavinato S, Pozzetto I, Stagni C, Parisatto B, Cattelan AM, Battagin G, Sarmati L, Parisi SG. HIV tropism switch in archived DNA of HIV-HCV subjects successfully treated with direct-acting antivirals for HCV infection. Sci Rep 2021; 11:9274. [PMID: 33927306 PMCID: PMC8085114 DOI: 10.1038/s41598-021-88811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
We described short-term HIV tropism changes occurring in peripheral blood mononuclear cells and the correlations with HIV DNA value in HIV-HCV co-infected patients cured for HCV disease and with undetectable HIV viremia or residual viremia (RV). Plasma HIV RNA, cellular HIV DNA and tropism were evaluated pre-HCV treatment (baseline, BL) and at 12(T1) and 24(T2) weeks after HCV treatment start. V3 sequences were interpreted using Geno2pheno and classified as R5 only if all three sequences had an FPR ≥ 10% and as X4 when at least one replicate sequence had an FPR < 10%. Forty-nine patients (21 with X4 and 28 with R5 virus) were enrolled. Five X4 patients and 9 R5 subjects experienced at least one tropism change,11 with RV:1/5 patients with X4 infection at BL switched at T1 versus 8/9 in the R5 group (p = 0.022977) and the difference was confirmed in subjects with RV (p = 0.02);6/9 R5 patients switching at T1 confirmed the tropism change at T2. No significant differences in HIV DNA values between patients with RV starting with a R5 or X4 tropism and experienced tropism switch or not were found. Short-term tropism switch involved almost a third of patients, in all but three cases with HIV RV. Being R5 at BL is associated to a higher instability, expressed as number of tropism changes and confirmed switch at T2.
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Affiliation(s)
- Monica Basso
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Daniela Zago
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | | | - Silvia Cavinato
- grid.411474.30000 0004 1760 2630Infectious Diseases Unit, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Irene Pozzetto
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Camilla Stagni
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Beatrice Parisatto
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Anna Maria Cattelan
- grid.411474.30000 0004 1760 2630Infectious Diseases Unit, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | | | - Loredana Sarmati
- grid.6530.00000 0001 2300 0941Infectious Diseases Clinic, Università Tor Vergata, Rome, Italy
| | - Saverio Giuseppe Parisi
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
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9
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Shih WL, Fang CT, Chen PJ. Chapter XX Antiviral Treatment and Cancer Control. Recent Results Cancer Res 2021; 217:325-354. [PMID: 33200371 DOI: 10.1007/978-3-030-57362-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hepatitis B virus (HBV), hepatitis C virus (HCV), human papilloma virus (HPV), Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), Kaposi's sarcoma-associated herpesvirus (KSHV), and Merkel cell polyomavirus (MCV) contribute to about 10-15% global burden of human cancers. Conventional chemotherapy or molecular target therapies have been used to treat virus-associated cancers. However, a more proactive approach would be the use of antiviral treatment to suppress or eliminate viral infections to prevent the occurrence of cancer in the first place. Antiviral treatments against chronic HBV and HCV infection have achieved this goal, with significant reduction in the incidence of hepatocellular carcinoma in treated patients. Antiviral treatments for EBV, KSHV, and HTLV-1 had limited success in treating refractory EBV-associated lymphoma and post-transplant lymphoproliferative disorder, KSHV-associated Kaposi's sarcoma in AIDS patients, and HTLV-1-associated acute, chronic, and smoldering subtypes of adult T-cell lymphoma, respectively. Therapeutic HPV vaccine and RNA interference-based therapies for treating HPV-associated infection or cervical cancers also showed some encouraging results. Taken together, antiviral therapies have yielded promising results in cancer prevention and treatment. More large-scale studies in a real-world setting are necessary to confirm the efficacy of antiviral therapy. Further investigation for more effective and convenient antiviral regimens warrants more attention.
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Affiliation(s)
- Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Jer Chen
- Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
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10
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Corma-Gómez A, Macías J, Lacalle-Remigio JR, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Alados JC, Real LM, Palacios R, Santos IDL, Imatz A, Pineda JA. HIV infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected-patients with advanced fibrosis. Clin Infect Dis 2020; 73:e2109-e2116. [PMID: 32766891 DOI: 10.1093/cid/ciaa1111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of HIV infection on the risk of developing hepatocellular carcinoma (HCC) in HCV-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). METHODS Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: 1) SVR with DAA-based combination; 2) Liver stiffness (LS) ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. RESULTS 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1-Q3) follow-up time of 43 (31-49) months, 19 (1.8%) patients developed HCC [11 (3.0%) HCV-monoinfected, 8(1.2%) HIV/HCV-coinfected individuals; p=0.013]. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC [sHR=0.27, 95% IC (0.08-0.90); p=0.034]. Predictors of HCC emergence were: HCV genotype 3 [sHR=7.9 (2.5-24.9); p<0.001], MELD score at SVR>10 [sHR=1.37 (1.01-1.86); p=0.043] and LS value at SVR [sHR=1.03 (1.01-1.06) for 1 kPa increase; p=0.011]. Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC [powered HR=0.33 (0.11-0.85)]. CONCLUSIONS Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV-coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J R Lacalle-Remigio
- Division of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Sevilla, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - M Serrano
- UnitofInfectiousDiseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - L M Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - A Imatz
- Unit of Infectious Diseases, Hospital Universitario Bellvitge, Barcelona, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
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11
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Impact of HIV on the survival of hepatocellular carcinoma in hepatitis C virus-infected patients. AIDS 2020; 34:1497-1507. [PMID: 32675563 DOI: 10.1097/qad.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Previous studies have suggested that hepatocellular carcinoma (HCC) has an aggressive presentation and a shorter survival in people with HIV (PWH). This could be due to later diagnosis or lower rates of HCC treatment, and not to HIV infection itself. AIM: :: To assess the impact of HIV on HCC survival in hepatitis C virus (HCV)-infected patients. METHODS Multicenter cohort study (1999-2018) of 342 and 135 HCC cases diagnosed in HIV/HCV-infected and HCV-monoinfected patients. Survival after HCC diagnosis and its predictors were assessed. RESULTS HCC was at Barcelona-Clinic Liver-Cancer (BCLC) stage 0/A in 114 (33%) HIV/HCV-coinfected and in 76 (56%) HCV-monoinfected individuals (P < 0.001). Of them, 97 (85%) and 50 (68%) underwent curative therapies (P = 0.001). After a median (Q1-Q3) follow-up of 11 (3-31) months, 334 (70%) patients died. Overall 1 and 3-year survival was 50 and 31% in PWH and 69 and 34% in those without HIV (P = 0.16). Among those diagnosed at BCLC stage 0/A, 1 and 3-year survival was 94 and 66% in PWH whereas it was 90 and 54% in HIV-negative patients (P = 0.006). Independent predictors of mortality were age, BCLC stage and α-fetoprotein levels. HIV infection was not independently associated with mortality [adjusted hazard ratio (AHR) 1.57; 95% confidence interval: 0.88-2.78; P = 0.12]. CONCLUSION HIV coinfection has no impact on the survival after the diagnosis of HCC in HCV-infected patients. Although overall mortality is higher in HIV/HCV-coinfected patients, this seem to be related with lower rates of early diagnosis HCC in HIV-infected patients and not with HIV infection itself or a lower access to HCC therapy.
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12
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Screening for Hepatocellular Carcinoma in HIV-Infected Patients: Current Evidence and Controversies. Curr HIV/AIDS Rep 2020; 17:6-17. [PMID: 31933273 DOI: 10.1007/s11904-019-00475-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize evidence regarding hepatocellular carcinoma (HCC) screening in the specific context of HIV infection and discuss areas of uncertainty. RECENT FINDINGS It has not been definitely established if HCC incidence in HIV/HCV-coinfected patients with cirrhosis is above the 1.5%/year threshold that makes screening cost-effective. Outside cirrhosis or HBV infection, available data do not support surveillance. The performance of currently recommended ultrasound (US) screening strategy is poor in HIV-infected patients, as rates of early-stage HCC detection are low. Magnetic resonance imaging-based surveillance strategies or liquid biopsy are innovative approaches that should be specifically tested in this setting. HIV-infected patients with cirrhosis are at risk of HCC. US surveillance identifies patients with early-stage HCC who will benefit of curative therapies, although the quality of the evidence supporting screening remains limited. The HIV population should be a priority group to assess and validate new surveillance strategies.
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13
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Corma-Gómez A, Macías J, Téllez F, Freyre-Carrillo C, Morano L, Rivero-Juárez A, Ríos MJ, Alados JC, Vera-Méndez FJ, Merchante N, Palacios R, Granados R, Merino D, De Los Santos I, Pineda JA. Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals. Clin Infect Dis 2019; 71:2354-2362. [DOI: 10.1093/cid/ciz1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA).
Methods
In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR.
Results
During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant.
Conclusions
LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - C Freyre-Carrillo
- Unit of Microbiology, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - D Merino
- Unit of Infectious Diseases, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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14
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Oka S, Ogata M, Takano M, Minamimoto R, Hotta M, Tajima T, Nagata N, Tsukada K, Teruya K, Kikuchi Y, Gatanaga H. Non-AIDS-defining malignancies in Japanese hemophiliacs with HIV-1 infection. Glob Health Med 2019; 1:49-54. [PMID: 33330754 DOI: 10.35772/ghm.2019.01015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/08/2022]
Abstract
Along improvement of prognosis of HIV-1-infected patients due to successful anti-retroviral therapy, main causes of death in the patients have been changing from AIDS to non-AIDS defining malignancies (NADM) recently. However, little is known about the prevalence and incidence of NADM in patients, and especially in HIV-1-infected hemophiliacs. We prospectively conducted NADM screening with FDG-PET, chest CT, upper gastrointestinal endoscopy, tumor markers, and stool occult blood in hemophiliacs with a mean age of 48.9 years. Screening was done twice from December 2016 through March 2019; the first screening was used to calculate prevalence in 69 patients and the second was used to calculate incidence in 56 patients. The first screening revealed 4 cases of malignancies; three were cases of thyroid cancer and one was a case of a neuroendocrine tumor in the pancreas; prevalence was 5.8% (95% CI: 0.2-11.4%). During a mean follow-up of 1.2 years with 68.2 person-years (PYs), cancer was diagnosed in 2 cases (pancreatic and liver cancer) during the second screening. Incidence was 2.99/100 PY. It can be speculated that there might be around 40 cases of undiagnosed NADM currently and 20 cases of new NADM annually in this population, because 718 HIV-1-infected hemophiliacs are surviving in Japan according to the 2018 Nationwide Survey on Coagulation Disorders. Screening for NADM in HIV-1-infected hemophiliacs at other hospitals is strongly recommended.
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Affiliation(s)
- Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mikiko Ogata
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Misao Takano
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryogo Minamimoto
- Department of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masatoshi Hotta
- Department of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsuyoshi Tajima
- Department of Diagnostic Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan.,Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kunihisa Tsukada
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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15
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Low performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma in HIV-infected patients. AIDS 2019; 33:269-278. [PMID: 30325782 DOI: 10.1097/qad.0000000000002065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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More than just oncogenes: mechanisms of tumorigenesis by human viruses. Curr Opin Virol 2018; 32:48-59. [PMID: 30268926 DOI: 10.1016/j.coviro.2018.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022]
Abstract
Most humans are infected with at least one of the known human cancer viruses during their lifetimes. While the initial infection with these viruses does not cause major disease, infected cells can acquire cancer hallmarks, particularly upon immunosuppression or exposure to co-carcinogenic stimuli. Even though cancer formation represents a rare outcome of a viral infection, approximately one out of eight human cancers has a viral etiology. Viral cancers present unique opportunities for prophylaxis, diagnosis, and therapy, as demonstrated by the success of HBV and HPV vaccines and HCV antivirals in decreasing the incidence of tumors that are caused by these viruses. Here we review common characteristics and mechanisms of action of the human oncogenic viruses.
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