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
