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Observational Study
. 2023 Mar 6;18(3):e0282539.
doi: 10.1371/journal.pone.0282539. eCollection 2023.

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Pantong M Davwar  1 , Edith Okeke  1 , Mary Duguru  1 , David Nyam  1 , Kristen Bell  2 , Emuobor A Odeghe  3 , Ganiat Oyeleke  3 , Olufunmilayo A Lesi  3 , Revika Singh  2 , Kwang-Youn Kim  2 , Godwin Imade  1 , Alani S Akanmu  3 , Atiene S Sagay  1 , Folasade T Ogunsola  3 , Marion G Peters  2 , Lewis R Roberts  4 , Lifang Hou  2 , Robert L Murphy  2 , Claudia A Hawkins  2
Affiliations
Observational Study

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Pantong M Davwar et al. PLoS One. .

Abstract

Introduction: Hepatocellular carcinoma (HCC) is an increasing cause of mortality in Nigeria among persons with HIV (PLH), as access to antiretroviral therapy (ART) improves. In this study we describe clinical, radiological, and laboratory characteristics in Nigerian adults with HCC, with and without HIV, and examine how HIV impacts survival.

Methods: This prospective observational study was conducted between August 2018 and November 2021 at two Nigerian hospitals [Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH)]. Subjects ≥18 years with HCC diagnosed according to American Association for the Study of Liver Diseases (AASLD) criteria were included. Baseline characteristics were compared, and Kaplan-Meier curves were generated to estimate survival.

Results: 213 subjects [177 (83%) without HIV and 36 (17%) with HIV (PLH)] were enrolled. Median age was 52 years (IQR 42,60) and most subjects were male (71%). 83% PLH were on antiretroviral therapy (ART). Hepatitis B surface antigen (HBsAg) positivity was similar between the two groups [91/177 (51%) without HIV vs. 18/36 (50%) with HIV; p = 0.86]. 46/213 (22%) subjects had active hepatitis C (anti-HCV+/HCV RNA>10 IU/mL). Cirrhosis was more common in PLH but there were no other significant differences in clinical and tumor characteristics between the groups. Overall, 99% subjects were symptomatic and 78% in late-stage HCC. Median overall survival was significantly shorter in PLH vs. without HIV (0.98 months vs 3.02 months, HR = 1.55, 95%CI 1.02, 2.37, p = 0.04). This association was not significant after adjusting for known risk factors including gender, current alcohol use, alpha-fetoprotein (AFP), albumin, and total bilirubin (HR = 1.38, 95%CI 0.84, 2.29, p = 0.21).

Conclusion: HCC presented late with an extremely poor overall prognosis, highlighting the urgent need for more intensive surveillance in Nigeria to diagnose HCC at earlier stages. Early diagnosis and management of viral hepatitis, and access to HCC therapies, could prevent early mortality among persons with HCC, especially among PLH.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overall survival by HIV status.
Fig 2
Fig 2. Overall survival by BCLC.
See this image and copyright information in PMC

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