Screening for hepatocellular carcinoma among adults with HIV/HBV co-infection in Zambia: a pilot study

Area of Science:

• Hepatology and Infectious Diseases
• Oncology
• Public Health in Sub-Saharan Africa

Background:

• Chronic hepatitis B virus (HBV) infection is a primary driver of hepatocellular carcinoma (HCC) in sub-Saharan Africa (SSA).
• Individuals with human immunodeficiency virus (HIV) and HBV co-infection on antiretroviral therapy (ART) represent a vulnerable population for HCC development.

Purpose of the Study:

• To pilot a hepatocellular carcinoma (HCC) screening initiative within an established cohort of HIV/HBV co-infected individuals receiving ART in Lusaka, Zambia.
• To assess the prevalence of significant liver lesions and fibrosis indicative of HCC or other liver damage in this co-infected population.

Main Methods:

• The study involved 279 patients co-infected with HIV and HBV undergoing ART.
• Abdominal ultrasound (AUS) and transient elastography were utilized for liver assessment.
• Key parameters assessed included transaminase levels, HBV viral load, CD4 counts, and imaging findings like hepatomegaly and fibrosis.

Main Results:

• A significant proportion of patients (55.7%) had elevated transaminases, and nearly 60% had high HBV levels (>2000 IU/mL).
• Over a quarter of participants (24.6%) exhibited significant fibrosis.
• Hepatomegaly (26.9%) and periportal fibrosis (24.7%) were common findings on AUS; five patients (1.8%) had liver lesions >1 cm requiring further investigation.

Conclusions:

• This pioneering HCC screening initiative in SSA identified significant liver lesions in 2% of HIV/HBV co-infected patients.
• A notable quarter of participants showed findings suggestive of schistosomiasis-induced liver damage, underscoring co-existing parasitic infections.
• The study emphasizes the critical need for integrated HCC surveillance and management strategies in resource-limited settings like sub-Saharan Africa.