Dika Imane El, Harding James J, Abou-Alfa Ghassan K
aMemorial Sloan Kettering Cancer Center bWeill Cornell Medical College, New York, New York, USA.
Curr Opin HIV AIDS. 2017 Jan;12(1):20-25. doi: 10.1097/COH.0000000000000335.
Hepatocellular carcinoma (HCC) is becoming an important cause of mortality in patients with HIV, attributed to coinfection with hepatitis C virus, hepatitis B virus, and the longer survival advantage these patients are achieving after introducing the highly active antiretroviral therapy (HAART) regimens.
In addition to hepatitis infection, immunosuppression secondary to HIV infection, direct impact of the virus on liver parenchyma, and the use of hepatotoxic antiretroviral drugs, all contribute to HCC pathogenesis. Screening is very important in this particular population; data on population-specific guidelines are still controversial and scarce. Liver transplantation remains the treatment of choice in eligible patients. Trials on sorafenib have not included patients with HIV; yet, we know from small retrospective series that it might be safe and effective.
In the HAART era, HCC is arising as a common non-AIDS defining cancer with high impact on morbidity and mortality of HIV-infected patients. Candidates for liver transplantation should be offered this option regardless of HIV infection. Safety and efficacy of sorafenib and other treatment modalities should be further studied and offered as deemed applicable to HIV patients diagnosed with HCC.
肝细胞癌（HCC）正成为HIV患者死亡的一个重要原因，这归因于丙型肝炎病毒、乙型肝炎病毒的合并感染，以及这些患者在采用高效抗逆转录病毒治疗（HAART）方案后获得的更长生存优势。
除了肝炎感染外，HIV感染继发的免疫抑制、病毒对肝实质的直接影响以及使用具有肝毒性的抗逆转录病毒药物，都对HCC的发病机制有影响。筛查在这一特定人群中非常重要；关于特定人群指南的数据仍然存在争议且稀缺。肝移植仍然是符合条件患者的首选治疗方法。索拉非尼的试验未纳入HIV患者；然而，我们从小型回顾性系列研究中得知，它可能是安全有效的。
在HAART时代，HCC正成为一种常见的非艾滋病定义性癌症，对HIV感染患者的发病率和死亡率有很大影响。肝移植候选人无论是否感染HIV都应提供这种选择。应进一步研究索拉非尼和其他治疗方式的安全性和有效性，并在适用于诊断为HCC的HIV患者时提供。
