Trends in Incidences and Risk Factors for Hepatocellular Carcinoma and Other Liver Events in HIV and Hepatitis C Virus-coinfected Individuals From 2001 to 2014: A Multicohort Study
Trends in Incidences and Risk Factors for Hepatocellular Carcinoma and Other Liver Events in HIV and Hepatitis C Virus-coinfected Individuals From 2001 to 2014: A Multicohort Study
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DOI：
10.1093/cid/ciw380
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发表时间：
2016-09-15
影响因子：
11.8
通讯作者：
Peters, Lars
中科院分区：
文献类型：
--
作者：
Gjaerde, Lars I.;Shepherd, Leah;Peters, Lars
背景资料。虽然在过去十年中，人类免疫缺陷病毒(HIV)和丙型肝炎病毒(丙型肝炎病毒)共同感染的人中与肝脏相关的死亡人数有所下降，但肝细胞癌(HCC)可能有所增加。我们描述了HIV/丙型肝炎病毒感染者的多队列协作中的肝细胞癌和其他肝脏事件的流行病学。2001年至2014年，我们在EuroSIDA研究、南艾伯塔省诊所队列、加拿大联合感染队列和瑞士HIV队列研究中研究了丙型肝炎抗体阳性的成年艾滋病毒感染者。我们计算了肝癌和其他肝脏事件(定义为与肝脏相关的死亡或失代偿，不包括肝癌)的发生率，并使用泊松回归估计发生率。我们的研究包括7229名艾滋病毒/丙型肝炎病毒混合感染者(68%是男性，90%是白人)。在随访期间，72例肝细胞癌和375例其他肝脏事件的发生率分别为1.6(95%可信区间，1.3，2.0)和8.6(95%可信区间，7.8，9.5)例/1000人年。肝细胞癌的发病率每年增加11%(95%可信区间，4%，19%)，其他肝脏事件的发病率下降4%(95%可信区间，2%，7%)，但只有后者在调整潜在混杂因素后仍具有统计学意义。年龄较大、肝硬变和当前的低CD4细胞计数与更高的肝癌和其他肝脏事件的发生率相关。在艾滋病毒/丙型肝炎混合感染者中，从2001年到2014年，肝细胞癌的粗发病率上升，而其他肝脏事件下降。有肝硬变或当前CD4细胞计数低的人发生肝细胞癌或其他肝脏事件的风险最高。
Background. While liver-related deaths in human immunodeficiency virus (HIV) and hepatitis C virus (HCV)-coinfected individuals have declined over the last decade, hepatocellular carcinoma (HCC) may have increased. We describe the epidemiology of HCC and other liver events in a multicohort collaboration of HIV/HCV-coinfected individuals.Methods. We studied HCV antibody-positive adults with HIV in the EuroSIDA study, the Southern Alberta Clinic Cohort, the Canadian Co-infection Cohort, and the Swiss HIV Cohort study from 2001 to 2014. We calculated the incidence of HCC and other liver events (defined as liver-related deaths or decompensations, excluding HCC) and used Poisson regression to estimate incidence rate ratios.Results. Our study comprised 7229 HIV/HCV-coinfected individuals (68% male, 90% white). During follow-up, 72 cases of HCC and 375 other liver events occurred, yielding incidence rates of 1.6 (95% confidence interval [CI], 1.3, 2.0) and 8.6 (95% CI, 7.8, 9.5) cases per 1000 person-years of follow-up, respectively. The rate of HCC increased 11% per calendar year (95% CI, 4%, 19%) and decreased 4% for other liver events (95% CI, 2%, 7%), but only the latter remained statistically significant after adjustment for potential confounders. Older age, cirrhosis, and low current CD4 cell count were associated with a higher incidence of both HCC and other liver events.Conclusions. In HIV/HCV-coinfected individuals, the crude incidence of HCC increased from 2001 to 2014, while other liver events declined. Individuals with cirrhosis or low current CD4 cell count are at highest risk of developing HCC or other liver events.