Low compliance with hepatocellular carcinoma screening guidelines in hepatitis B/C virus co-infected HIV-patients with cirrhosis. Journal of Viral Hepatitis
Willemse et al. for the Collaboration of Observational HIV on behalf of Epidemiological Research Europe (COHERE) in EuroCoord aimed to assess compliance with hepatocellular carcinoma (HCC) screening guidelines in a large European cohort of HIV‐infected patients with hepatitis B virus (HBV-) and/or hepatitis C (HCV-) co‐infection and cirrhosis. Of note, it is recommended in multiple inter‐national guidelines (AASLD, EASL and EACS) to screen individuals with cirrhosis twice a year with ultrasound for the presence of HCC.
Data from 646 individuals were selected for analysis. Of these patients, 518 (80%) were HCV co‐infected, 85 (13%) HBV co‐infected and 43 (7%) HCV and HBV co‐infected. The proportion of patients in whom HCC screening was performed according to screening guidelines varied between 5.4% in 2005, 18.4% in 2008 and 14.2% in 2014. In the multivariate analysis, longer follow‐up after cirrhosis diagnosis (OR 1.59; 95% CI 1.36‐1.87) and cirrhosis diagnosis based on liver biopsy or Fibroscan (OR 1.68; 1.11‐2.55) were independently associated with a higher compliance. Lack of ALT measurements (OR 0.52; 95% CI 0.31 0.86 compared with normal ALT levels) was associated with a lower compliance. More recent calendar year of follow‐up, included as a time‐updated variable to the model, was not significantly associated with better compliance.
In conclusion, this study in a prospective European cohort of HBV and/or HCV co‐infected HIV patients with cirrhosis showed a very low rate of compliance to bi‐annual HCC screening guidelines of only 14%‐18%. In the context of an increasing incidence of HCC among ageing people living with HIV, this finding warrants urgent action to ensure better implementation of HCC screening guidelines in this population.