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AIDS. 2019 Feb 1;33(2):269-278. doi: 10.1097/QAD.0000000000002065.

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

Author information

1
Unidad de Enfermedades Infecciosas y Microbiología.
2
Unidad de Aparato Digestivo, Hospital Universitario de Valme, Sevilla.
3
Unidad de Enfermedades Infecciosas, Hospital Universitario de Donostia, San Sebastián.
4
Unidad de Enfermedades Infecciosas, Hospital German Trias i Pujol, Badalona.
5
Unidad de Enfermedades Infecciosas, Hospital de Basurto, Bilbao.
6
Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario de Valencia, Valencia.
7
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante.
8
Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe, Valencia.
9
Unidad de Enfermedades Infecciosas, Hospital Universitario de Puerto Real, Hospital de La Línea, Instituto de Investigación e Innovación en Ciencias Biomédicas de la provincia de Cádiz (INiBICA), Cádiz.
10
Unidad de Enfermedades Infecciosas, Hospital General de Valencia, Valencia.
11
Unidad de Enfermedades Infecciosas, Instituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba.
12
Unidad de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga.
13
Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla.
14
Unidad de Enfermedades Infecciosas, Hospital Txagorritxu, Vitoria.
15
Unidad de Enfermedades Infecciosas, Hospital de Galdakao, Galdakao.
16
Unidad de Enfermedades Infecciosas, Hospital de Cruces, Bilbao.
17
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Santa Lucía, Cartagena.
18
Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga.
19
Servicio de Medicina Interna, Hospital La Magdalena, Castellón.
20
Unidad de Enfermedades Infecciosas, Hospital La Princesa, Madrid.
21
Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada.
22
Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén.
23
Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.

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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