Screening for Hepatocellular Carcinoma in HIV-Infected Patients: Current Evidence and Controversies

Curr HIV/AIDS Rep. 2020 Feb;17(1):6-17. doi: 10.1007/s11904-019-00475-0.

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.

Keywords: Cirrhosis; HIV; Hepatitis C virus; Hepatocellular carcinoma; Screening; Surveillance.

Publication types

  • Review

MeSH terms

  • Carcinoma, Hepatocellular / diagnosis*
  • Carcinoma, Hepatocellular / pathology
  • Chronic Disease Indicators
  • Coinfection / virology
  • Cost-Benefit Analysis
  • HIV Infections / complications*
  • Hepacivirus
  • Hepatitis C, Chronic / complications*
  • Humans
  • Incidence
  • Liver Cirrhosis / complications*
  • Liver Neoplasms / diagnosis*
  • Liver Neoplasms / pathology
  • Magnetic Resonance Imaging
  • Mass Screening