The use of antiviral drugs that allow the suppression of the liver virus reduces by almost two thirds the risk of developing hepatocellular carcinoma

An American study, the results of which have been published in the journal Hepatology, has revealed that people co-infected with HIV and the hepatitis B virus (HBV) are at increased risk of developing hepatocellular carcinoma when hepatitis B is active. However, including HBV-active drugs in the antiretroviral regimen significantly reduces the risk of liver cancer, as long as hepatitis B viral suppression is maintained.

 

Worldwide, chronic hepatitis B is one of the most common causes of hepatocellular carcinoma, the most common type of liver cancer. Although coinfection with HIV and HBV is common, the effects of this double infection on the risk of developing liver cancer are not well understood. Some antiretroviral drugs used to treat HIV are also active against HBV, and experts recommend that coinfected people include drugs with a mechanism of action against both viruses in their antiretroviral regimen (tenofovir is an HIV drug that also has activity versus HBV).

In order to offer more evidence on this question, a team of researchers from the Perelman School of Medicine of the University of Pennsylvania (USA) set out to evaluate the factors that contribute to the development of hepatocellular carcinoma in a study of multiple cohorts of patients. people co-infected with HIV and HBV. They examined data from two decades (1995-2016) in 22 cohorts from the North American Collaborative Cohort on AIDS Research and Design (NA-ACCORD) and analyzed people co-infected with the two viruses.

The study included a total of 8,354 people co-infected with HIV and HBV. The majority (93%) were male, the majority (52%) non-white, and the mean age was 43 years. The researchers confirmed the diagnosis of hepatocellular carcinoma in the participants by reviewing medical records or a cancer registry. 115 cases of hepatocellular carcinoma were identified over 65,392 person-years of follow-up, with an incidence rate of 1.8 cases per 1,000 person-years (95% confidence interval: 1.5-2.1) .

Among participants who were on antiretroviral treatment that included active hepatitis B drugs for more than a year, the risk of hepatocellular carcinoma was significantly lower, 58% .When there was no HBV viral suppression, the risk of liver cancer among people co-infected with HIV and HBV it was much higher.

 

Risk factors for hepatocellular carcinoma included an age between 40 and 49 years (adjusted hazard ratio [RRa]: 1.97; 95% CI: 1.22-3.17), an age equal to or greater than 50 years (RRa : 2.55; 95% CI: 1.49-4.35), hepatitis C virus-HCV- coinfection (HR: 1.61; 95% CI: 1.07-2.40) and consumption alcohol problem (CRa: 1.52; 95% CI: 1.04-2.23). On the other hand, an updated HIV RNA determination of less than 500 copies / mL (HR: 0.90; 95% CI: 0.56-1.43) and an updated percentage of CD4 + lower than that were not risk factors for hepatocellular carcinoma. 14% (CRa: 1.03; 95% CI: 0.56-1.90).

The risk of hepatocellular carcinoma increased with an updated determination of HBV DNA greater than 200 IU / mL (HR: 2.22; 95% CI: 1.42-3.47) and was higher with each increase of 1.0 log10 IU / mL in updated HBV DNA (CRa: 1.18; 95% CI: 1.05-1.34). Suppression of HBV with antiretroviral therapy for a year or more significantly reduced the risk of hepatocellular carcinoma (HR: 0.42; 95% CI: 0.24-0.73).

The team of researchers also indicated that advanced age, triple infection with HIV, HBV and HCV and problematic consumption of alcoholic beverages were factors that increased the risk of developing liver cancer. In this sense, they point out that reducing alcohol consumption and receiving direct-acting antiviral therapy against HCV can help reduce this risk.

One aspect the study authors also highlight is that most HIV doctors do not regularly monitor hepatitis B viral load in practice, even while patients are receiving antiretroviral treatment. They indicate that periodic evaluation of HBV viral load and achieving suppression of this liver virus is important during antiretroviral treatment in people with HIV and chronic HBV coinfection.

In conclusion, the researchers note that their study findings underscore the importance of regular testing and care for people coinfected with HIV and chronic hepatitis B, as well as the value of programs and strategies that help people coinfected to maximize adherence to antiretroviral therapy to achieve hepatitis B viral suppression.

 

Source: POZ /Elaboración propia (gTt-VIH).

References: Kim HN, Newcomb CW, Carbonari DM, Roy JA, Torgersen J, Althoff KN, et al. Risk of Hepatocellular Carcinoma with Hepatitis B Viremia among HIV/Hepatitis B Virus-Coinfected Persons in North America.Hepatology, 29 March 2021. https://doi.org/10.1002/hep.31839

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