Risk factors for liver Cancer in HIV endemic areas of Western Kenya

Impact of HIV Infection on Hepatocellular Carcinoma: A Long-Term Prognostic Analysis

Purpose: This study aims to explore the influence of human immunodeficiency virus (HIV) infection on the prognosis of patients with hepatocellular carcinoma (HCC). Methods: According to the search strategy, we searched all relevant articles in the three databases (PubMed, Embase, and the Cochrane Library) up to February 18, 2024. All data available for analysis were extracted. Continuous variables were expressed as mean difference (MD) with standard deviation (SD). The categorical variables were expressed as odds ratio (OR) with 95% confidence intervals (CIs). Forest plots were used to illustrate the analysis results, and funnel plots were used to assess publication bias. Results: The study included a total of 4544 subjects. HIV patients were significantly younger compared to those without HIV (MD = -16.13, 95% CI = -17.24 to -15.01, I2 = 91, P < .01), but there were no significant differences in other relevant clinical characteristics between the groups. Survival analysis indicated that HIV patients exhibited a poorer long-term prognosis compared with HIV-negative patients (HR = 0.71, 95% CI = 0.63 to 0.79, I2 = 29%, P < .01). Conclusion: HIV infection, which compromises immune function and liver health, predisposes individuals to earlier onset of HCC and is associated with a poorer prognosis.

Treating liver cancer through arginine depletion

Liver cancer, the sixth most common cancer globally and the second-leading cause of cancer-related deaths, presents a critical public health threat. Diagnosis often occurs in advanced stages of the disease, aligning incidence with fatality rates. Given that established treatments, such as stereotactic body radiation therapy and transarterial radioembolization, face accessibility and affordability challenges, the emerging focus on cancer cell metabolism, particularly arginine (Arg) depletion, offers a promising research avenue. Arg-depleting enzymes show efficacy against Arg-auxotrophic cancers, including hepatocellular carcinoma (HCC). Thus, in this review, we explore the limitations of current therapies and highlight the potential of Arg depletion, emphasizing various Arg-hydrolyzing enzymes in clinical development.

Systemic Diseases and Gastrointestinal Cancer Risk

Importance

Gastrointestinal (GI) cancers are the second leading cause of cancer-related deaths worldwide.

Observations

The global challenges GI cancers pose are high, especially in middle- and low-income countries. Patients with these cancers present with symptoms of poor appetite, weight loss, heartburn, abdominal pain, fatigue and anaemia. Several risk factors contribute to GI cancers, including age, gender, obesity, pathogenic infections, smoking cigarettes, alcohol consumption and dietary habits. Most of these cancers are sporadic. However, some patients are at high risk due to a family history of GI cancers. Systemic diseases affect multiple organs, and their chronic occurrence elicits inflammatory responses at various sites. These diseases also contribute to GI cancers.

Conclusion and Relevance

In this review, we discuss that untreated systemic diseases, including diabetes, hepatitis, acquired immune deficiency syndrome, ulcers and hypertension, can potentially lead to GI cancers if they remain untreated for a longer period. Systemic diseases initiate oxidative stress, inflammatory pathways and genetic manipulations, which altogether confer risks to GI cancers. Here, we describe the association between systemic diseases and their underlying mechanisms leading to GI cancers.

Survival outcomes in veterans with hepatocellular carcinoma, with and without HIV infection

BACKGROUND

HIV infection has been associated with survival disparities among persons with hepatocellular carcinoma (HCC). However, most studies examining survival do not control for provider (e.g. type of HCC treatment given) or individual-level factors (e.g. homelessness, substance use) that could impact survival. In this study, we evaluate the effect of HIV status on survival among persons with HCC, in a comprehensive model that accounts for key individual, provider, and systems-level factors.

METHODS

We conducted a retrospective cohort study of persons with HIV (PWH) matched 1 : 1 to HIV-negative controls based on age and year of HCC diagnosis in the national Veterans Administration (VA) health system. The primary outcome was survival. We used Cox regression models to evaluate the effect of HIV status on risk of death.

RESULTS

This cohort included 200 matched pairs diagnosed with HCC between 2009 and 2016. A total of 114 PWH (57.0%) and 115 HIV-negative patients (57.5%) received guideline-concordant therapy ( P  = 0.92). Median survival was 13.4 months [95% confidence interval (CI) 8.7-18.1] among PWH and 19.1 months (95% CI 14.6-24.9) for HIV-negative patients. In adjusted models, older age, homelessness, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and not receiving any HCC treatment predicted risk of death. HIV status was not associated with risk of death [adjusted hazard ratio (aHR) 0.95; 95% CI 0.75-1.20; P  = 0.65].

CONCLUSION

HIV status was not associated with worse survival among HCC patients, in a single-payer, equal access healthcare system. These results suggest that HIV infection alone should not exclude PWH from receiving standard therapy.

The impact of HIV infection on clinical presentation and mortality among persons with hepatocellular carcinoma in Kampala, Uganda

BACKGROUND

HIV infection is associated with more rapid progression of some comorbidities. This study assessed the impact of HIV-infection on the presentation and outcome of HCC.

METHODS

HCC patients attending the Mulago National Referral Hospital in Uganda were enrolled into a natural history study of HCC between March 2015 and February 2019. Standardized methods were used to collect clinical, ultrasound and laboratory data at enrolment. HCC cases were confirmed and enrolled based on a combination of clinical, ultrasound, tumor marker and pathology data. Follow-up contact was made at one, three, six, and twelve months post-enrolment to determine vital status. Symptoms and signs at diagnosis and subsequent survival were compared by HIV status. Kaplan Meier curves were used to assess HCC survival.

RESULTS

Of 441 persons with HCC, 383 (87.0%) died within 12 months following HCC diagnosis. The median (IQR) survival was 42 (20, 106) days. HIV infection was present in 79 (18%) cases. After adjusting for baseline demographic and clinical characteristics, HIV infection was associated with increased mortality but only among those with severe HIV-associated immunosuppression (CD4 count < 200 cells per cubic milliliter), aHR (95% C) = 2.12 (1.23-3.53), p = 0.004, and not among PLWH with ≥ 200 CD4 cells per cubic milliliter, aHR (95% C) = 1.15 (0.82-1.60), p = 0.417.

CONCLUSION

Among relatively young Ugandans, HCC is a devastating disease with rapid mortality that is especially rapid among people living with HIV(PLWH). HIV was associated with slightly higher mortality, notably among PLWH with lower CD4 cell counts. As a substantial majority of PLWH diagnosed with HCC were engaged in HIV care, further investigation should determine the effectiveness of incorporating screening and early identification of HCC among high-risk individuals into existing HIV care programs. Concurrent with growing access to curative localized treatment for HCC in sub-Saharan Africa, leveraging HIV care infrastructure affords opportunities for earlier HCC intervention.

The role of infections in the causation of cancer in Kenya

Cancer constitutes a major health care burden in the world today with the situation worsening in resource poor settings as seen in most Sub-Saharan African (SSA) countries. Infections constitute by far the most common risk factors for cancer in SSA and being a typical country in this region, Kenya has experienced an upsurge in the incidence of various types of cancers in the last few decades. Although there is limited population-based data in Kenya of infections-associated cancers, this review provides an up-to-date literature-based discussion on infections-associated cancers, their pathogenesis, and preventive approaches in the country. The primary infectious agents identified are largely viral (human immunodeficiency virus, human papillomavirus (HPV), Kaposi's sarcoma-associated herpes virus, Epstein-Barr virus, hepatitis B virus (HBV), hepatitis C virus), and also bacterial: Helicobacter pylori and parasitic: Schistosomiasis haematobium. Cancers associated with infections in Kenya are varied but the predominant ones are Non-Hodgkin lymphoma, Kaposi's sarcoma, Hodgkin lymphoma, Burkitt's lymphoma, cervical, liver, and gastric cancers. The mechanisms of infections-induced carcinogenesis are varied but they mainly seem to stem from disruption of signaling, chronic inflammation, and immunosuppression. Based on our findings, actionable cancer-preventive measures that are economically feasible and aligned with existing infrastructure in Kenya include screening and treatment of infections, implementation of cancer awareness and screening, and vaccination against infections primarily HBV and HPV. The development of vaccines against other infectious agents associated with causation of cancer remains also as an important goal in cancer prevention.

Prevalence of HIV and Its Co-Infection with Hepatitis B/C Virus Among Chronic Liver Disease Patients in Ethiopia

Background

The efficient use of antiretroviral drugs has significantly reduced AIDS-related morbidities and mortalities; however, mortality due to non-AIDS-related end-stage liver diseases is escalating in those living with HIV.

Objective

The study was designed to determine the prevalence of HIV and its co-infection with HBV and HCV among chronic liver disease (CLD) patients in Ethiopia.

Methods

Three hundred and forty-five CLD patients were included in this study in two groups: Hepatocellular carcinoma (HCC) (n=128) and non-HCC (n=217) patients. The non-HCC group comprised patients with advanced liver disease (n=98) and chronic hepatitis (n=119). Enzyme immunoassays were used to determine HBV and HCV infection markers. In addition, a serial rapid HIV testing algorithm was employed to screen HIV infection.

Results

Regardless of the stage of liver disease, the overall frequency of HIV was 4.3% (15/345), with a 2% (7/345) and 0.3% (1/345) of HIV/HBV and HIV/HCV co-infection rate. Of all HIV-infected patients (n=15), 46.7% (7/15) and 6.7% (1/15) were co-infected with HBV (HBsAg⁺HBcAb⁺) and HCV (anti-HCV⁺ HCV-RNA⁺), respectively, and 86.7% (13/15) exhibited a marker of HBV exposure (total HBcAb⁺). Overall, the frequency of HIV and its co-infection with HBV was more noticeable among HCC than non-HCC patients [8.6% (11/128) vs 1.8 (4/217), p=0.005 and 3.9% (5/128) vs 0.9% (2/217), p=0.1]. The rate of HIV mono-infection was 3.9% (5/128) vs 0.9% (2/217) among HCC and non-HCC patients.

Conclusion

The frequency of HIV and its co-infections with HBV/HCV exhibited an increasing pattern with the severity of the liver disease. Thus, screening all HIV-positive patients for HBV and HCV infection and all CLD patients for HIV infection and taking necessary preventive measures would be an essential strategy to prevent the progression of CLD and death related to liver disease in people living with HIV.

Hepatitis B virus infection and hepatocellular carcinoma in sub-Saharan Africa: Implications for elimination of viral hepatitis by 2030?

Elimination of viral hepatitis in sub-Saharan Africa by 2030 is an ambitious feat. However, as stated by the World Health Organization, there are unprecedented opportunities to act and make significant contributions to the elimination target. With 60 million people chronically infected with hepatitis B virus (HBV) of whom 38800 are at risk of developing highly fatal hepatocellular carcinoma (HCC) every year, sub-Saharan Africa faces one of the greatest battles towards elimination of viral hepatitis. There is a need to examine progress in controlling the disproportionate burden of HBV-associated HCC in sub-Saharan Africa within the context of this elimination target. By scaling-up coverage of hepatitis B birth dose and early childhood vaccination, we can significantly reduce new cases of HCC by as much as 50% within the next three to five decades. Given the substantial reservoir of chronic HBV carriers however, projections show that HCC incidence and mortality rates in sub-Saharan Africa will double by 2040. This warrants urgent public health attention. The trends in the burden of HCC over the next two decades, will be determined to a large extent by progress in achieving early diagnosis and appropriate linkage to care for high-risk chronic HBV infected persons.

Comparative Analysis of Presentation and Outcome After Liver Resection of Patients With Hepatocellular Carcinoma With and Without HIV

OBJECTIVE

Evidence shows that HIV infection may affect the survival outcome of patients with hepatocellular carcinoma (HCC). In this article, we aimed to determine whether HIV affected the overall survival of patients with HCC in China and ascertain the risk factors.

DESIGN

Retrospective cohort study.

METHODS

Participants were enrolled from a single medical center in Guangzhou, China. Survival was assessed using Kaplan-Meier plots and compared using the log-rank test. A multivariable Cox regression analysis was used to assess the effect of HIV seropositivity on patient overall survival while accounting for common prognostic factors.

RESULTS

The Kaplan-Meier plots showed that the median survival time of patients who were HIV-positive was 18 months shorter than that of their HIV-negative counterparts (P = 0.00, log rank). The 1- and 3-year rates of survival for HIV-positive patients were 65.4% and 29.9%, which were 93.3% and 79.1% for HIV-negative patients. The death rate due to tumor recurrence and liver failure in the HIV-positive patients was apparently higher than those of the HIV-negative patients (tumor recurrence, 42.3% vs. 17.3%, P = 0.016; liver failure, 19.2% vs. 2.7%, P = 0.012, respectively). Independent factors predicting survival were initial presentation, HIV serostatus, United Network of Organ Sharing-modified tumor-node-metastasis stage, Barcelona Clinic Liver Cancer stage, aspartate aminotransferase, histological pattern, and microvascular invasion.

CONCLUSIONS

HIV-positive subjects with HCC have a poorer survival outcome than their HIV-negative counterparts, with tumor recurrence and liver failure as the main causes of death. Despite adequate curative therapy, HIV serostatus is associated with decreased survival of patients with HCC, independent of symptomatic presentation, tumor staging, and liver function.

Reduced expression of microRNA-139-5p in hepatocellular carcinoma results in a poor outcome: An exploration the roles of microRNA-139-5p in tumorigenesis, advancement and prognosis at the molecular biological level using an integrated meta-analysis and bioinformatic investigation

Hepatocellular carcinoma (HCC) is generally considered one of the most common gastrointestinal malignant tumors, characterized by high invasiveness and metastatic rate, as well as insidious onset. A relationship between carcinogenicity and aberrant microRNA-139-5p (miR-139-5p) expression has been identified in multiple tumors while the specific molecular mechanisms of miR-139-5p in HCC have not yet been thoroughly elucidated. A meta-analysis of available data from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus, ArrayExpress and Oncomine databases, as well as the published literature, was comprehensively conducted with the aim of examining the impact of miR-139-5p expression on HCC. Additionally, predicted downstream target genes were confirmed using a series of bioinformatics tools. Moreover, a correlative biological analysis was performed to ascertain the precise function of miR-139-5p in HCC. The results revealed that the expression of miR-139-5p was noticeably lower in HCC compared with non-tumor liver tissues according to the pooled standard mean difference, which was -0.84 [95% confidence interval (CI): -1.36 to -0.32; P<0.001]. Furthermore, associations were detected between miR-139-5p expression and certain clinicopathological characteristics of TCGA samples, including tumor grade, pathological stage and T stage. Moreover, the pooled hazard ratio (HR) for overall survival (HR=1.37; 95% CI: 1.07-1.76; P=0.001) indicated that decreased miR-139-5p expression was a risk factor for adverse outcomes. Additionally, 382 intersecting genes regulated by miR-139-5p were obtained and assembled in signaling pathways, including 'transcription factor activity, sequence-specific DNA binding', 'pathways in cancer' and 'Ras signaling pathway'. Notably, four targeted genes that were focused in 'pathways in cancer' were identified as hub genes and immunohistochemical staining of the proteins encoded by these four hub genes in liver tissues, explored using the Human Protein Atlas database, confirmed their expression patterns in HCC and normal liver tissues Findings of the present study suggest that reduced miR-139-5p expression is capable of accelerating tumor progression and is associated with a poor clinical outcome by modulating the expression of downstream target genes involved in tumor-associated signaling pathways.

Impact of contrast ultrasound diagnosis for patients with liver cancer

BACKGROUND

Numerous studies have reported that contrast ultrasound (CU) can be utilized for diagnosis in patients with liver cancer (LC) accurately. However, no systematic review has addressed to assess its diagnostic impact on patients with LC. Thus, this systematic review will investigate the accurate of CU diagnosis on LC.

METHODS

A comprehensive literature search for relevant studies will be performed in the Cochrane Library, EMBASE, MEDILINE, Web of Science, PSYCINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inceptions to the March 10, 2019. All case-controlled studies investigating the impacts of CU diagnosis on LC will be included in this study. Two researchers will independently carry out study selection, quality assessment, and data extraction. The quality will be assessed by using Quality Assessment of Diagnostic Accuracy Studies tool. Statistical analysis will be conducted by RevMan V.5.3 (Cochrane Community, London, UK) and Stata V.12.0 software (Stata Corp, College Station).

RESULTS

This study will present the accuracy of CU diagnosis for patients with LC through the assessment of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CU.

CONCLUSION

The findings of this study will summarize the current evidence for accuracy of CU diagnosis in patients with LC.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019127108.