Riebensahm, C.; Chitundu, H.; Muula, G.; Chihota, B.; Sinkala, E.; Sunkutu, V.; Maurer, Martin; Dufour, J. F.; Berzigotti, A.; Egger, M.; Bolton-Moore, C.; Vinikoor, M.; Wandeler, G. (2022). Screening for Hepatocellular Carcinoma among adults with HIV/Hepatitis B coinfection in Zambia: A Pilot Study. International journal of infectious diseases, 116, pp. 391-396. Elsevier 10.1016/j.ijid.2021.12.338
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Background & aims: Chronic hepatitis B virus (HBV) infection is the main cause of hepatocellular carcinoma (HCC) in sub-Saharan Africa (SSA). In an established cohort of HIV/HBV-coinfected individuals on antiretroviral therapy (ART), we piloted an HCC screening initiative at two outpatient clinics in Lusaka, Zambia.
Methods: We performed abdominal ultrasound (AUS) and transient elastography in all patients.
Results: Among 279 HIV/HBV-coinfected patients, 165 (59.1%) were men, median age was 34 years (interquartile range 28-39) and median CD4 count 246 cells/µl (112-355). While 102 (36.6%) individuals had elevated transaminases, 114 (40.9%) had HBV levels >2000 IU/mL and 59 (24.6%) significant fibrosis. On AUS, 75 (26.9%) participants had hepatomegaly and 69 (24.7%) peri-portal fibrosis. Five patients had a liver lesion >1cm, an indication for confirmatory imaging.
Conclusions: In one of the first HCC screening initiatives in SSA, 2% of HIV/HBV-coinfected adults had significant liver lesions, and a quarter had findings suggestive of schistosomiasis-induced liver damage.
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