MacDonald Douglas C, Nelson Mark, Bower Mark, Powles Thomas
Chelsea and Westminster hospital, London, United Kingdom.
World J Gastroenterol. 2008 Mar 21;14(11):1657-63. doi: 10.3748/wjg.14.1657.
The incidence of hepatocellular carcinoma (HCC) in patients with human immunodeficiency virus (HIV) is rising. HCC in HIV almost invariably occurs in the context of hepatitis C virus (HCV) or hepatitis B virus (HBV) co-infection and, on account of shared modes of transmission, this occurs in more than 33% and 10% of patients with HIV worldwide respectively. It has yet to be clearly established whether HIV directly accelerates HCC pathogenesis or whether the rising incidence is an epiphenomenon of the highly active antiretroviral therapy (HAART) era, wherein the increased longevity of patients with HIV allows long-term complications of viral hepatitis and cirrhosis to develop. Answering this question will have implications for HCC surveillance and the timing of HCV/HBV therapy, which in HIV co-infection presents unique challenges. Once HCC develops, there is growing evidence that HIV co-infection should not preclude conventional therapeutic strategies, including liver transplantation.
人类免疫缺陷病毒（HIV）感染者中肝细胞癌（HCC）的发病率正在上升。HIV相关的HCC几乎总是在丙型肝炎病毒（HCV）或乙型肝炎病毒（HBV）合并感染的情况下发生，由于传播途径相同，全球分别有超过33%和10%的HIV感染者合并感染这两种病毒。HIV是否直接加速HCC的发病机制，或者发病率上升是否是高效抗逆转录病毒治疗（HAART）时代的一种附带现象，目前尚不清楚。在HAART时代，HIV感染者寿命延长，使得病毒性肝炎和肝硬化的长期并发症得以发展。回答这个问题将对HCC监测以及HCV/HBV治疗的时机产生影响，而在HIV合并感染的情况下，这带来了独特的挑战。一旦发生HCC，越来越多的证据表明，HIV合并感染不应排除包括肝移植在内的传统治疗策略。
