Hepatitis B virus-associated hepatocellular carcinoma in South Africa in the era of HIV

Tongai Gibson Maponga¹, Richard H Glashoff^{2

3}, Hannali Vermeulen⁴, Barbara Robertson⁵, Sean Burmeister⁶, Marc Bernon⁶, Jones Omoshoro-Jones⁷, Paul Ruff⁸, Alfred I Neugut^{9

10

11}, Judith S Jacobson^{10

11}, Wolfgang Preiser^{12

3}, Monique I Andersson^{12

13}

Affiliations

¹ Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa. tongai@sun.ac.za.
² Division of Medical Microbiology & Immunology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
³ Tygerberg Business Unit, National Health Laboratory Service, Cape Town, South Africa.
⁴ Division of Radiation Oncology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
⁵ Division of Radiation Oncology, University of Cape Town, Cape Town, South Africa.
⁶ Department of Surgery, University of Cape Town, Cape Town, South Africa.
⁷ Department of Surgery, University of Witwatersrand, Johannesburg, South Africa.
⁸ Division of Medical Oncology, University of Witwatersrand, Johannesburg, South Africa.
⁹ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.
¹⁰ Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA.
¹¹ Mailman School of Public Health, Columbia University, New York, USA.
¹² Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
¹³ Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

PMID: 32660431
PMCID: PMC7359588
DOI: 10.1186/s12876-020-01372-2

Hepatitis B virus-associated hepatocellular carcinoma in South Africa in the era of HIV

Tongai Gibson Maponga et al. BMC Gastroenterol. 2020.

. 2020 Jul 13;20(1):226.

doi: 10.1186/s12876-020-01372-2.

Authors

Affiliations

¹ Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa. tongai@sun.ac.za.
² Division of Medical Microbiology & Immunology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
³ Tygerberg Business Unit, National Health Laboratory Service, Cape Town, South Africa.
⁴ Division of Radiation Oncology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
⁵ Division of Radiation Oncology, University of Cape Town, Cape Town, South Africa.
⁶ Department of Surgery, University of Cape Town, Cape Town, South Africa.
⁷ Department of Surgery, University of Witwatersrand, Johannesburg, South Africa.
⁸ Division of Medical Oncology, University of Witwatersrand, Johannesburg, South Africa.
⁹ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.
¹⁰ Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA.
¹¹ Mailman School of Public Health, Columbia University, New York, USA.
¹² Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
¹³ Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

PMID: 32660431
PMCID: PMC7359588
DOI: 10.1186/s12876-020-01372-2

Abstract

Background: Patients co-infected with hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are at risk of developing hepatocellular carcinoma (HCC). In sub-Saharan Africa, the overlap between high HIV and HBV prevalence may increase the incidence of HCC. This study investigated the impact of HBV/HIV co-infection on age at presentation and survival of HCC.

Methods: Ethical approval was obtained to recruit, following informed written consent, patients diagnosed with HCC at oncology units at four South African hospitals. Between December 2012 and August 2015, patients newly diagnosed with HCC were recruited and provided demographic and clinical data and blood specimens. Patients were tested for HBV, hepatitis C virus (HCV) and HIV. Survival data was available for a subset of patients.

Results: Of 107 HCC cases, 83 (78%) were male. Median age was 46 years (range 18 to 90 years), 68/106 (64%) were HBsAg-positive, and 22/100 (22%) were HIV infected. Among HBV surface antigen (HBsAg)-positive HCC cases, 18/66 (27%) were HIV-infected compared to 3/34 (9%) among those that were HBsAg-negative (p = 0.04). A greater proportion of HBV/HIV co-infected cases were female than HBV mono-infected (6/18, 33% vs 6/47, 13%; p = 0.005). In addition, HBV/HIV co-infected females presented at a younger mean age (36.8 years) than HBV mono-infected women (50.5 years) (p = 0.09). Median survival was 82 days among the HIV-infected HCC patients compared to 181 days among those without HIV (p = 0.15).

Conclusions: HCC is an important complication in the HIV/HBV infected patient. HIV-positive patients presented with HCC at a younger age than HIV-negative patients, this effect appears to be greater in women. These data provide more evidence supporting the call to address. HCC as a cause of morbidity and mortality in the HBV/HIV co-infected patient population. (281 words).

Keywords: Age at presentation; HIV infection; Hepatitis B infection; Hepatocellular carcinoma; Natural history; Survival.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Survival rates according to known HIV status. Comparison between Kaplan–Meier survival curves in 22 HIV-infected patients with HCC and 78 HIV-uninfected HCC patients. Patients whose HIV status was unknown were not included in this survival analysis

See this image and copyright information in PMC

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Hepatitis B virus-associated hepatocellular carcinoma in South Africa in the era of HIV

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Hepatitis B virus-associated hepatocellular carcinoma in South Africa in the era of HIV

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Conflict of interest statement

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