1. Low performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma in HIV-infected patients
- Author
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Junta de Andalucía, European Commission, Instituto de Salud Carlos III, Merchante, Nicolás, Figueruela, Blanca, Rodríguez-Fernández, Miguel, Rodríguez-Arrondo, Francisco, Revollo, Boris, Ibarra, Sofía, Galindo, María José, Merino, Esperanza, Montero, Marta, Téllez, Francisco, García-Deltoro, Miguel, Rivero-Juárez, Antonio, Delgado-Fernández, Marcial, Ríos-Villegas, María José, Aguirrebengoa, Koldo, García, María A., Portu, Joseba, Vera-Méndez, Francisco Jesús, Villalobos, Marina, Mínguez, Carlos, De Los Santos, Ignacio, López-Ruz, Miguel A., Omar, Mohamed, Galera-Peñaranda, Carlos, Macías Sánchez, Juan, Pineda, Juan A., Junta de Andalucía, European Commission, Instituto de Salud Carlos III, Merchante, Nicolás, Figueruela, Blanca, Rodríguez-Fernández, Miguel, Rodríguez-Arrondo, Francisco, Revollo, Boris, Ibarra, Sofía, Galindo, María José, Merino, Esperanza, Montero, Marta, Téllez, Francisco, García-Deltoro, Miguel, Rivero-Juárez, Antonio, Delgado-Fernández, Marcial, Ríos-Villegas, María José, Aguirrebengoa, Koldo, García, María A., Portu, Joseba, Vera-Méndez, Francisco Jesús, Villalobos, Marina, Mínguez, Carlos, De Los Santos, Ignacio, López-Ruz, Miguel A., Omar, Mohamed, Galera-Peñaranda, Carlos, Macías Sánchez, Juan, and Pineda, Juan A.
- Abstract
[Objective]: To assess the performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma (HCC) in HIV-infected patients., [Methods]: 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., [Results]: 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)., [Conclusion]: 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.
- Published
- 2019