Lack of compliance to hepatocellular carcinoma (HCC) screening guidelines in hepatitis B (HBV) or C (HCV) virus co-infected HIV patients with cirrhosis
AASLD LiverLearning®. Willemse S. Nov 14, 2016; 144654
Topic: Health Care Delivery/Quality/Effectiveness
Label: Health Care Delivery/Access/Quality
Sophie Willemse
Sophie Willemse
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TITLE: Lack of compliance to hepatocellular carcinoma (HCC) screening guidelines in hepatitis B (HBV) or C (HCV) virus co-infected HIV patients with cirrhosis

This study was not sponsored.

Background The incidence of HCC in HBV or HCV HIV-co-infected patients is increasing possibly due to an increase in the prevalence of cirrhosis. Guidelines recommend HCC screening every 6 months in patients with cirrhosis. We assessed compliance with HCC screening guidelines in HBV and HCV HIV-co-infected patients with cirrhosis.
Methods Patients were enrolled from 4 cohorts from The Netherlands, France, Austria and Italy participating in the COHERE collaboration (www. and followed between 1 January 2005 and 1 January 2015. HBV co-infection was defined as being HBsAg positive and HCV co-infection as HCV antibody-positive. Assessment of liver cirrhosis was based on a) clinical diagnosis reported in the chart, b) liver biopsy, c) fibroscan result (>11.8 kPa for HBV and >12.6 kPa for HCV), or d) APRI score >2.0. Compliance to national and European HCC screening guidelines was defined as at least one ultrasound every 6.5 months. Generalized estimating equation (GEE) models adjusted for repeated measurements were fitted to determine the predictors of the lack of compliance to HCC screening guidelines.
Results 1,743 HIV-infected patients with HBV and/or HCV co-infection and liver cirrhosis were included. Of the 1,743 patients 1,306 (75%) were HCV co-infected, 320 (18%) HBV co-infected and 117 (7%) were HBV/HCV co-infected. The majority of patients were male (80%), Caucasian (83%) and infected with HIV by injecting drug use (IDU; 44%), homosexual contact (MSM; 32%) or heterosexual contact (14%). Median age at cirrhosis diagnosis was 43 years (IQR: 36-48) and median follow up time since diagnosis of cirrhosis was 6.0 years (IQR: 4-10); 96% of the patients used cART at time of diagnosis and 79% had HIV RNA ≤400 copies/ml. Screening ≤ 6.5 months was performed in 5% of the individuals in 2006, and 7% in 2014. Injecting drug use and longer time since diagnosis of cirrhosis were associated with a higher compliance to HCC screening, whilst HBV&HCV co-infection, lack of ALT measures and assessment of cirrhosis by APRI score were associated with a lower compliance (figure 1). Sensitivity analyses, in which all patients with a cirrhosis assessment by APRI score were excluded, and in which the allowed time between ultrasound measures was extended to 9, 12, 15 and 24 months, all showed comparable associations.
Conclusion Compliance to HCC screening recommendations in at-risk HBV and/or HCV HIV-co-infected patients is low in Europe. In the light of an aging population and subsequently an increasing prevalence of liver cirrhosis this is a situation that needs to be addressed urgently.
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