Hepatocellular Carcinoma Screening in Patients Co-Infected With Human Immunodeficiency Virus and Hepatitis B: A Phase 1 Quality Assessment Report

Abstract

Introduction: In the US, about 5% to 10% of people diagnosed with HIV also have chronic HBV infection. Patients coinfected with HIV and HBV have a higher rate of progressing to liver cirrhosis, endstage liver disease, or hepatocellular carcinoma compared to individuals mono-infected. Furthermore, coinfected patients are also at higher risk for morbidity and mortality [1]. Given our current therapeutic armamentarium, neither can fully be eradicated. This is particularly due to the development of antiviral drug resistance after patients have received treatment for some time and followed by the loss of clinical efficacy. Coinfection by these two viruses leads to poor clinical outcomes and intensifies their negative effects. The goal of this study is to determine whether or not patients at The Brooklyn Hospital Center who are coinfected with HIV and HBV are being adequately screened for hepatocellular carcinoma. Determining the screening status of our patients will enable us to tailor intervention programs to improve screening and management practices of patients coinfected with these two viruses. Methods: A total of 43 patients were identified in a retrospective charts review from 2015 to 2018 who were co-infected with HIV and HBV and fit the inclusion criteria of our study. The screening criteria for adequate screening was abdominal ultrasound every 6 months from the time of diagnoses of HIV and HBV. Descriptive statistics were used to compare contiguous and categorical variables. Results: Out of the 43 patients included in our chart review, about 70% (n=30) of patients identified were male. Average basic metabolic index was 31.5. The majority (n=31) were Black, followed by Caucasian (n=8) and Hispanic (n=3). Median age was 50.5 ± 12 years. All patients did not have a family history of hepatocellular carcinoma. The average CD4 count was 498.9 Units. 3 patients were diagnosed with liver cirrhosis. The majority of patients (79%, n=34) were never screened for hepatocellular carcinoma via ultrasound or were only screened once after initial diagnosis. Conclusion: Phase 1 of our quality assessment has revealed that co-infected with HIV and HBV are not being adequately screened for hepatocellular carcinoma. Phase 2 will focus on implementing educational interventions aimed at increasing physician awareness of screening guidelines.