Hepatobiliary cancers in persons With HIV/AIDS in the United States
© Sahasrabuddhe et al; licensee BioMed Central Ltd. 2012
Published: 19 April 2012
Cancers of the hepatobiliary tract (liver, bile duct and gall bladder) are characterized by relatively infrequent occurrence, aggressive growth, and recurrences after treatment. Hepatocellular carcinoma (HCC) is of special concern in the context of HIV/AIDS due to substantial associated morbidity and mortality. The overall burden of liver cancer may increase in people with AIDS as the combined effects of alcohol use, coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV), and other risk factors manifest as chronic liver disease.
Registry linkage data from the U.S. HIV/AIDS Cancer Match Study were used to estimate standardized incidence ratios (SIRs) to compare the risk of hepatobiliary cancers in people with HIV/AIDS to the general population. We also estimated rate ratios (RRs) of HCC by HIV risk group, calendar period and AIDS status. HIV risk groups were categorized by HCV prevalence [high prevalence: hemophiliacs, injection drug users (IDUs), and IDU-men who had sex with men (MSM); and low prevalence: heterosexuals, non-IDU MSM, and others].
This study reinforces the primary role of HCV coinfection in HCC pathogenesis in persons with AIDS in the United States. HCC risk is higher in people with AIDS than people with HIV infection without AIDS, consistent with a contribution from prolonged immunosuppression. Rising HCC incidence in the era of HAART suggests that HAART itself does not fully correct the negative impact of HIV on HCV-related cirrhosis, and that access to appropriate anti-HCV therapies in HIV-infected individuals is critical for prevention of progression to HCC.
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