Liver cancer seen as common risk for men with hemophilia and HIV
This cancer's incidence 23 times higher in patients than other men in Japan
Men with hemophilia and infected with the human immunodeficiency virus (HIV) are at a high risk of developing certain types of cancer that are more likely in people with HIV, according to a recent study in Japan.
These cancers, called non-acquired immunodeficiency syndrome-defining malignancies or NADMs, included liver cancer, which was found to be about 23 times more common among hemophilia patients with HIV than the general male population in Japan.
“Our findings emphasised the elevated risk of malignancies in [people with hemophilia and HIV], underscoring the need for early cancer screening and preventive measures, particularly against liver cancers, even in younger [patients],” the researchers wrote.
The study, “Non-acquired immunodeficiency syndrome defining malignancies in people living with haemophilia and human immunodeficiency virus after direct-acting antiviral era,” was published in Global Health and Medicine.
Study into cancers tied to HIV among men in Japan with hemophilia
Hemophilia is caused mainly by mutations in genes that provide instructions to make clotting factors — proteins that are essential for the blood to clot. As a consequence, people with hemophilia either produce a faulty version of a clotting factor, or are unable to produce sufficient amounts of it.
Clotting factor deficiency places patients at an increased risk of excessive bleeding, a characteristic disease symptom that is generally managed and prevented with hemophilia treatments like replacement therapies, which provide a version of the clotting protein patients lack.
Estimates indicate that around 30% of hemophilia patients in Japan contracted HIV, the virus that causes AIDS (acquired immunodeficiency syndrome), through contaminated blood products manufactured before 1986. With the introduction of antiretroviral therapies to manage HIV, the risk of liver cancer and other NADMs has increased among those with hemophilia and HIV.
Researchers at various Japanese medical centers analyzed the incidence of NADMs in these patients via a nationwide mail survey sent to select hospitals across the country between May 2022 and February 2023.
In total, 64 hospitals treating 328 people with hemophilia and HIV — corresponding to 47.1% of the 697 people with both conditions in Japan — responded to the questionnaire. A total of 35 NADM cases were diagnosed in these 328 patients between January 2015 to December 2021, and mostly in men with a median age of 51, which the scientists considered to be “relatively young” for such cancers. Most of the patients, 74%, had hemophilia A (74%).
Most common were liver cancer, colon cancer and lymphoma
Almost all those with NADMs (97%) had antibodies for the virus that causes hepatitis C. The most common NADM types were liver cancer (43%), followed by colon cancer (14%), lymphoma (9%), and thyroid and tongue cancer (6% each).
“The observed young age of the affected [people with hemophilia and HIV] in this survey may be a critical finding. Co-infection with HIV and [hepatitis C virus], which increases the risk of [liver cancer], may have contributed to this observation,” the researchers wrote.
Most patients (77%) were diagnosed during regular health screenings, while in 23% the diagnosis occurred after the appearance of symptoms. Malignancy, or cancer spreading to other organs, was present at diagnosis in 29% of the patients.
Regarding treatment, most patients required surgery (60%). In 68% of the cases, complete cancer remission was achieved, with treatment lasting more than six months in about half of the patients. Six deaths were attributed to this type of cancer.
Among patients age 50 or younger, researchers found that 47% had liver cancer, and 27% died from NADMs.
The standardized incidence ratio — the ratio between the number of cancer cases seen in people with hemophilia and HIV and the number of expected cases in the general male population in Japan — then was calculated.
This analysis showed the number of liver cancer cases to be 23.1 times higher in this patient group than what would be expected across the country’s general male population. For thyroid cancer, the incidence was 9.4 times higher among people with hemophilia and HIV.
“Because [people with hemophilia and HIV] regularly attend HIV core hospitals, there is a need to establish an efficient system that can detect cancer in its early stages and promote patient education,” the researchers wrote.
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