Portal de Periódicos da CAPES

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

2018; Lippincott Williams & Wilkins; Volume: 33; Issue: 2 Linguagem: Inglês

10.1097/qad.0000000000002065

1473-5571

Nicolás Merchante, Blanca Figueruela, Miguel Rodríguez-Fernández, Francisco Rodríguez-Arrondo, Boris Revollo, Sofía Ibarra, Marı́a José Galindo, Esperanza Merino, Marta Montero, Francisco Téllez, Miguel García Deltoro, Antonio Rivero‐Juárez, Marcial Delgado‐Fernández, Maria José Ríos-Villegas, Koldo Aguirrebengoa, M.Á. Bonillo García, Joseba Portu, Francisco Jesús Vera-Méndez, Marina Villalobos, Carlos Mínguez, Ignacio de los Santos, Miguel Ángel López‐Ruz, Mohamed Omar, Carlos Galera, Juan Macı́as, Juan A. Pineda,

Hepatocellular Carcinoma Treatment and Prognosis

To assess the performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma (HCC) in HIV-infected patients.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.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).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.