Hepatitis B virus and HIV infection among patients with primary hepatocellular carcinoma in Kampala, Uganda

Abstract

Background: Hepatitis B virus (HBV) is the commonest cause of primary hepatocellular (PHC) carcinoma worldwide. Co-infection with the HIV leads to more rapid progression of liver disease.

Objectives: We described prevalence of HBV and HIV among patients with PHC admitted to Mulago Hospital, Kampala, Uganda.

Methods: We assessed all patients admitted to the gastrointestinal service of Mulago hospital with a diagnosis of PHC for HBV and HIV infection.

Results: From March to June 2008, we recruited 15 patients. Nine (60%) were male; the overall median age was 32 years (IQR 15 -67), with median ages for male and female 33 and 36 years respectively. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and AFP were all elevated with median values of 57.5 IU/L, 222 IU/L, 392 IU/L and 362 ng/ml respectively (IQR 14-145, 49-393, 165-1294 and 7-480). Eight (53%) patients were from North and Northeastern Uganda. The HBsAg was reactive in 13(87%) patients and HIV in 3(20%), all of whom were also co-infected with HBV.

Conclusion: There is high prevalence of HBV and HBV/HIV co-infection among patients with PHC in Uganda with high mortality. Reduction in incidence and mortality due to PHC in Uganda will require urgent large scale HBV vaccination.

Keywords: HIV; Hepatitis B; Primary Hepatocelular Carcinoma.

Figure 1a

H and E stain of liver tissue showing hyperchromatic cells forming trabeculae. (Magnification X200)

Figure 1b

H and E stain of liver tissue showing hyperchromatic pleomorphic cells of fibrolamellar type hepatocellular carcinoma (arrows). (Magnifications ×200