Specific Issues in the Management of Hepatocellular Carcinoma in Hepatitis B Virus/Hepatitis C Virus-Human Immunodeficiency Virus Co-infected Patients

Hepatocellular carcinoma (HCC) has become in recent years a leading cause of morbidity and mortality in patients with HIV who are co-infected with HBV/HCV. The aim of this review is to describe the peculiarities of HCC occurring in this highly demanding scenario, covering all topics from diagnosis to treatment. The epidemiology of co-infection with hepatitis B and C is covered. The following sections deal with suggestions and recommendations about screening, diagnosis and treatment. The key role of liver ultrasound imaging and serum alpha-fetoprotein determination for HCC early diagnosis in patients at high risk for HCC development is underscored. All current treatments of HCC in this special population are described and commented, i.e. surgical resection, percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization, targeted therapy, liver transplant. Special consideration has been given to the issues hindering the access of HIV patients with HCC to liver transplantation programmes. We hint to the much awaited availability of highly efficacious anti-HCV Directly Active Antivirals. In fact, the advent of these molecules is likely to produce a deep impact on and a dramatic improvement of the natural history of HIV/HCV co-infections. In summary, HCC incidence in patients with HIV who are co-infected with HBV/HCV is on the rise. Early diagnosis is essential to treat patients with the most efficacious treatment options. Treatment of all three viral infections is the key intervention to prevent occurrence of HCC in this population. Nevertheless, large prospective trials are badly needed to assess the optimal management of patients who have cleared HCV but still risk to develop a liver malignancy.