Penn Medicine Study Suggests Long-term Suppression of Hepatitis B in Patients Who Are HIV-coinfected May Lower Cancer Risk
Hepatitis B in the Blood Raises Risk of Hepatocellular Carcinoma Among HIV/Hepatitis B-Coinfected Patients
May 21, 2021 - PHILADELPHIA - While the risk of hepatocellular carcinoma (HCC) – primary liver cancer – is higher among patients who have HIV, it’s even higher among patients who have HIV and detectable hepatitis B, according to research from the Perelman School of Medicine at the University of Pennsylvania. Among participants with HIV and hepatitis B, suppressing detectable hepatitis B infection with the use of antiretroviral therapy cut the risk of developing HCC by 58 percent. These findings suggest that the best care for individuals with HIV and detectable hepatitis B includes sustained hepatitis B suppression with antiretroviral therapy in order to cut the risk of developing HCC. The study is published in the journal Hepatology.
It has been suggested that ART slows hepatitis C-associated liver fibrosis; however, whether rates of severe liver
complications in patients co-infected with HIV and hepatitis C receiving ART were similar to those with just
hepatitis C remained unclear.
The study, published in the March 18 issue of Annals of Internal Medicine , examinedelectronic medical record dataof 4,280
patients infected with both HIV and chronic hepatitis C virus who were receiving ART, and 6,079 hepatitis C-only
patients receiving care between 1997 and 2010.
It found that the HIV/hepatitis C-co-infected patients had an 80 percent higher rate of decompensated cirrhosis than
hepatitis C-only patients. Even when co-infected patients had controlled HIV virus in response to ART, they still
had a 60 percent higher rate of serious liver disease compared to those with hepatitis C alone.
HCC affects approximately 25,000 people each year in the United States and is considered a very aggressive type of cancer. Internationally and in the United States, chronic hepatitis B is a leading cause of HCC through direct and indirect effects on the liver. Additionally, chronic hepatitis B is common among patients who have HIV.
In order to study the predictors of HCC among people co-infected with HIV and chronic hepatitis B, the researchers used data from the North American AIDS Cohort Collaboration on Research and Design, which contains health information spanning two decades. The study population included data from over 8,000 people co-infected with HIV and chronic hepatitis B. Those with detectable HIV and detectable hepatitis B had a higher likelihood of developing HCC compared to those who had both viruses suppressed. Antiretroviral treatment for chronic hepatitis B reduced the risk of developing HCC, and the risk dropped substantially when hepatitis B viremia was suppressed to undetectable levels and when the viral suppression lasted at least a year.
“Most HIV providers do not regularly monitor hepatitis B viral load in practice, even while on antiretroviral treatment,” said senior author Vincent Lo Re III, MD, MSCE, an associate professor of Medicine and Epidemiology at Penn Medicine. “Our data highlight the importance of regular assessment of hepatitis B viral load and achievement of hepatitis B suppression during antiretroviral therapy in people with HIV and chronic hepatitis B coinfection.” In addition, maintaining adherence can be a challenge for certain patients depending on their overall health and other factors. “This study highlights the importance of testing and regular care for HIV and chronic hepatitis B co-infected individuals as well as the value of programs and strategies that help co-infected individuals maximize antiretroviral adherence to achieve hepatitis B viral suppression.”
According to Dr. Lo Re and his team, including lead author H. Nina Kim, MD, MSc, an associate professor of medicine at University of Washington, heavy alcohol use and coinfection with hepatitis C were also associated with an increased risk of HCC among individuals with HIV and chronic hepatitis B co-infection. The study authors advise that reducing excessive drinking and using direct-acting antiviral therapy targeted to chronic hepatitis C infection could also help to lower the risk of liver cancer in dually infected people.
The study was supported by the National Institute of Allergy and Infectious Diseases (R21-AI124868).
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Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions
of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman
School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of
Pennsylvania Health System, which together form a $4.3 billion enterprise.
The Perelman School of Medicine is currently ranked #2 in U.S. News & World Report's survey of research-oriented medical
schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $479.3
million awarded in the 2011 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania
-- recognized as one of the nation's top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania
Hospital - the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services
throughout the Philadelphia region.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities.
In fiscal year 2011, Penn Medicine provided $854 million to benefit our community.
Source: Penn Medicine
https://www.pennmedicine.org/news/news-releases/2021/may/penn-study-suggests-long-term-suppression-of-hepatitis-b-in-hiv-patients-may-lower-cancer-risk
Contact:
Alex Gardner
C: 215-873-3870
O: 215-349-8062
alex.gardner@pennmedicine.upenn.edu
"Reproduced with permission - Penn Medicine: University of Pennsylvania"
Penn Medicine: University of Pennsylvania
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