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Semin Liver Dis 2012; 32(02): 186-192
DOI: 10.1055/s-0032-1316470
Diagnostic Problems in Hepatology
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hepatocellular Carcinoma in a Noncirrhotic Patient with HIV: A Case Report and Review of the Literature

Neil Parikh
1   Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY
,
Valerie Martel-Laferriere
1   Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY
,
Xuchen Zhang
2   The Lillian and Henry M. Stratton – Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, NY
,
Douglas Dieterich
1   Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY
,
Maria Isabel Fiel
2   The Lillian and Henry M. Stratton – Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, NY
,
Ponni Perumalswami
1   Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY
› Author Affiliations
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Publication History

Publication Date:
03 July 2012 (online)

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Abstract

A 59-year-old man with human immunodeficiency virus (HIV) was referred for persistently elevated liver enzyme activities. His HIV was well controlled on antiretroviral therapy and his viral load was undetectable. He had no history of chronic liver disease and had minimal alcohol intake. He was asymptomatic and his physical exam was unremarkable without any stigmata of liver disease. Beyond the elevations in alkaline phosphatase and gamma-glutamyl transferase, the rest of his laboratory work, including viral hepatitis serologies and serum α-fetoprotein, was within normal limits. A computed tomography (CT) scan revealed a mildly nodular liver but hepatic mass or ascites was not seen. He was subsequently followed every 3 to 6 months without any change in his clinical symptoms, laboratory values, or imaging tests. Two years after the original visit, the patient presented with acute onset of abdominal pain, an AFP of 15.8 ng/mL, and a 9-cm hepatic mass on imaging. Given his preserved liver function, he underwent right hepatic lobectomy. Histologic examination of the resected tissue was consistent with hepatocellular carcinoma (HCC). The uninvolved liver was noncirrhotic and unremarkable except for mild portal inflammation. As the vast majority of HIV patients who develop HCC have established chronic liver diseases such as hepatitis B and/or C along with cirrhosis, this case of HCC in an HIV patient without cirrhosis or viral hepatitis is rare. Although current screening guidelines recommend imaging only for patients with HIV and hepatitis B/C cirrhosis, closer monitoring may be important in HIV patients with even subtle liver dysfunction.

Keywords

human immunodeficiency virus - hepatocellular carcinoma - hepatitis B virus - hepatitis C virus - noncirrhotic liver
 

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