MOAB0204

Title

Assessment of risk factors for hepatocellular carcinoma in HIV care and treatment programs across 31 countries: A cross-sectional survey

Presenter

Catrina Mugglin

Authors

C. Mugglin¹, P. Coffie², F. Dabis³, M. Kuniholm⁴, P. Easterbrook⁵, J. Ross⁶, A. Avihingsanon⁷, C. McGowan⁸, M. Yotebieng⁹, K. Anastos¹⁰, M. Urassa¹¹, S. Duda⁸, M.-A. Davies¹², M. Egger¹, G. Wandeler¹, IeDEA Collaboration

Institutions

¹University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, ²Programme PACCI, CHU Treichville Site de Recherches ANRS, Abidjan, Cote D'Ivoire, ³University of Bordeaux, Bordeaux School of Public Health (ISPED), Bordeaux, France, ⁴University at Albany, State University of New York, Department of Epidemiology and Biostatistics, Rensselaer, United States, ⁵Infectious Disease Institute, Kampala, Uganda, ⁶TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand, ⁷HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, ⁸Vanderbilt University School of Medicine, Nashville, United States, ⁹Ohio State University, Columbus, United States, ¹⁰Albert Einstein College of Medicine, Department of Epidemiology and Population Health, New York, United States, ¹¹The TAZAMA Project, National Institute for Medical Research, Mwanza, Tanzania, United Republic of, ¹²University of Cape Town, Cape Town, South Africa

Background: Liver cancer is the fourth leading cause of cancer death worldwide. According to the 2015 Global Burden of Disease Study, alcohol, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the three main causes of hepatocellular carcinoma (HCC). We assessed diagnostic practices for these risk factors in >50 HIV clinics across the world.
Methods: Cross-sectional web-based survey among HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA); 55 HIV clinics from 31 countries in 6 different regions participated. Data were collected from December 2014 to September 2015.
Results: The majority of sites were from low-income countries (36%) or lower-middle-income countries (31%), with 3 (5%) from high-income countries. Thirty-eight (69%) sites were tertiary-care facilities and 44 (80%) were located in urban settings. Sites followed over 550,000 HIV-positive individuals. Routine HBV testing ranged from 22-100% of sites across regions, and routine HCV testing from 0-80% (Figure). When any HBV testing was performed, 32 (58%) sites used a rapid HBV surface antigen test and 17 (31%) a laboratory-based serological test. HBV viral load was performed in less than 25% of sites across regions. Of the 47 (85%) sites reporting any HCV antibody testing, none used rapid tests and HCV viral load was available in 5 (9%) clinics. Alcohol consumption was routinely assessed in 29 (53%) sites, with 12 (39%) using a structured assessment tool (e.g., AUDIT-C). Five (9%) sites reported having an ongoing screening program for HCC.
Conclusions: Although HBV and HCV testing were conducted in the majority of surveyed HIV clinics, only a minority performed it routinely, with large variation across regions, including across high burden countries. Confirmation of HBV and HCV replication and assessment of hazardous alcohol consumption, the most important modifiable HCC risk factors, were poorly implemented globally.

[Screening practices and diagnostic tools for HBV, HCV and alcohol consumption in 55 sites across 6 IeDEA regions]

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