Insulin resistance is associated with a higher risk of hepatocellular carcinoma in cirrhotic HIV/HCV-co-infected patients: Results from ANRS CO13 HEPAVIH

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• 作者：Dominique Salmon¹ ; ^&dagger ; ; Firouzé ; Bani-Sadr¹ ; ^&dagger ; ; ^{firouze.bani-sadr@tnn.ap-hop-paris.fr} ; Marc-Arthur Loko² ; ^&dagger ; ; Hind Stitou³ ; ^&dagger ; ; Anne Gervais⁴ ; ^&dagger ; ; Jacques Durant⁵ ; ^&dagger ; ; Eric Rosenthal⁶ ; ^&dagger ; ; Yann Quertainmont⁷ ; ^&dagger ; ; Karl Barange⁸ ; ^&dagger ; ; Daniel Vittecoq⁹ ; ^&dagger ; ; Michka Shoai-Tehrani¹⁰ ; ^&dagger ; ; Muriel Alvarez¹¹ ; ^&dagger ; ; Maria Winnock² ; ^&dagger ; ; Jean Claude Trinchet¹² ; ^&dagger ; ; Fran&ccedil ; ois Dabis² ; ^&dagger ; ; Philippe Sogni¹³ ; ^&dagger ;
• 关键词：Hepatocellular carcinoma ; Insulin resistance ; HIV/HCV-co-infection
• 刊名：Journal of Hepatology
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：56
• 期：4
• 页码：862-868
• 全文大小：584 K

文摘

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Background & Aims

Compared to HCV-mono-infected patients, hepatocellular carcinoma (HCC) occurs at younger age in HIV/HCV-co-infected patients, is markedly more advanced at diagnosis, is less amenable to curative treatment, and has a more severe outcome. The aim of this study was to identify factors predictive of HCC occurrence in a large cohort of HIV/HCV-co-infected patients with cirrhosis.

Methods

This study involved 244 HIV/HCV-co-infected patients included in the ANRS CO13 HEPAVIH cohort, who had HCV-related cirrhosis (clinically or histologically proven cirrhosis, or liver stiffness ?2.5 kPa) and no signs of HCC at baseline. Cox proportional hazards models were used to identify factors associated with HCC occurrence.

Results

During a median follow-up of 2.6 (IQR, 1.8-3.5) years, 21 patients (8.6 % ) developed HCC. Diagnosis of HCC was based on histology in 5 patients (24 % ) and non-invasive criteria in 16 patients (76 % ). In univariate analyses, the following factors were related to HCC occurrence: age, previous cirrhosis decompensation, a HOMA value >3.8 (patients with treated diabetes were excluded from the HOMA calculation), a lower platelet count, a lower prothrombin level, and higher alpha-fetoprotein levels. The HOMA value was >3.8 at baseline in 66.7 % of patients who developed HCC and in 35.3 % of the remaining patients (p = 0.016). In multivariate analysis, age over 50 years (adjusted RR 3.2, 95 % CI 1.2-9.0; p = 0.02) and a HOMA value >3.8 (adjusted RR 3.4, 95 % CI 1.1-10.3; p = 0.03) remained significantly associated with HCC occurrence.

Conclusions

As in HCV-mono-infected patients with HCV-related cirrhosis, insulin resistance appears to play a key role in HCC occurrence in HCV/HIV-co-infected patients with cirrhosis. This finding calls for specific screening strategies for patients with a particularly high risk of developing HCC.