Service d'hépato-gastroentérologie, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, UFR SMBH, université Paris-13, 93143 Bondy cedex, France.
Clin Res Hepatol Gastroenterol. 2012 Jun;36(3):214-21. doi: 10.1016/j.clinre.2011.11.002. Epub 2011 Dec 19.
Since HAART, primary liver cancer has emerged as an increasing cause of morbidity and mortality in patients with HIV infection. Our aim was to compare characteristics and outcome of primary liver cancer according to HIV status in HCV cirrhotic patients submitted to periodic ultrasonographic surveillance.
All patients with primary liver cancer and cirrhosis were selected from two prospective cohorts (ANRS CO12 Cirvir, viral cirrhosis, n=1081; ANRS CO13 Hepavih, HIV-HCV coinfection, n=1175). Cirrhosis was diagnosed by liver biopsy in monoHCV group and biopsy and/or non-invasive tests in HIV-HCV group. Ultrasonographic surveillance was performed every 6 months. Diagnosis of primary liver cancer was established according to EASL-AASLD guidelines.
Primary liver cancer was diagnosed in 32 patients, 16 in each group, and corresponded to hepatocellular carcinoma in all except for two cholangiocarcinomas in HIV-HCV patients. Ultrasonographic follow-up was similar (median time since last ultrasonographic without focal lesion: 237 days in HIV-HCV group (n=12) versus 208 days in HCV group, NS). At primary liver cancer diagnosis HIV-HCV patients were markedly younger (48 vs. 60 yrs, P<0.001), primary liver cancer was more advanced in HIV-HCV patients (single nodule: 43% vs. 75%, P=0.07; mean diameter of main nodule: 24 vs. 16 mm, P=0.006; portal obstruction: 3 vs. 0). Curative treatment was performed in four HIV-HCV patients versus 11 HCV patients (P=0.017). During follow-up, 10 HIV-HCV patients died versus only one HCV patient (P=0.0005).
This result suggests more aggressiveness for tumors in HIV infected patients and, if confirmed, could result in shortening the length between ultrasonographic examinations.
自高效抗逆转录病毒治疗（HAART）以来，原发性肝癌已成为 HIV 感染者发病率和死亡率上升的一个原因。我们的目的是比较 HCV 肝硬化患者定期超声监测时，根据 HIV 状态原发性肝癌的特征和结局。
从两个前瞻性队列（ANRS CO12 Cirvir，病毒性肝硬化，n=1081；ANRS CO13 Hepavih，HIV-HCV 合并感染，n=1175）中选择所有原发性肝癌和肝硬化患者。在单 HCV 组中通过肝活检诊断肝硬化，在 HIV-HCV 组中通过活检和/或非侵入性检查诊断肝硬化。每 6 个月进行一次超声监测。根据 EASL-AASLD 指南建立原发性肝癌的诊断。
在 32 名患者中诊断出原发性肝癌，每组 16 名，除了 2 名 HIV-HCV 患者为胆管细胞癌外，其余均为肝细胞癌。超声随访相似（HIV-HCV 组（n=12）最后一次无局灶性病变超声检查至原发性肝癌诊断的中位时间为 237 天，与 HCV 组（n=12）的 208 天相比，无统计学差异（NS）。在原发性肝癌诊断时，HIV-HCV 患者明显更年轻（48 岁 vs. 60 岁，P<0.001），HIV-HCV 患者的原发性肝癌更晚期（单发结节：43% vs. 75%，P=0.07；主结节平均直径：24 毫米 vs. 16 毫米，P=0.006；门脉阻塞：3 例 vs. 0 例）。在 HIV-HCV 患者中进行了 4 例根治性治疗，而在 HCV 患者中进行了 11 例（P=0.017）。在随访期间，10 名 HIV-HCV 患者死亡，而只有 1 名 HCV 患者死亡（P=0.0005）。
这一结果表明 HIV 感染患者的肿瘤侵袭性更强，如果得到证实，可能会导致超声检查之间的时间间隔缩短。
