Current Tools to Diagnose and Predict Hepatocellular Carcinoma: Relevance to HIV and Hepatitis B Virus Coinfection.

Purpose of review: People with HIV and HBV coinfection have increased risk of developing liver fibrosis and hepatocellular carcinoma (HCC) compared to either infection alone. We review current and emerging tools for HCC diagnosis and prediction in the context of HIV-HBV coinfection.

Recent findings: Treatment with antiviral therapy and the goal of full viral suppression of both HBV and HIV remains foundational to care for people with HIV-HBV coinfection. All patients with chronic HBV and elevated risk, including cirrhosis or HIV infection, should undergo HCC screening. Tools exist to risk stratify patients with HBV without cirrhosis include PAGE-B, AFP-based tests, GALAD, and ct-DNA liquid biopsy. A limitation is that only PAGE-B has been validated in people with HIV-HBV coinfection. Current tools for HCC detection in people with HIV-HBV coinfection are generally limited to those developed in people with HBV monoinfection, with exception of PAGE-B. Future development of tools to predict and diagnose HCC are needed for people with HIV-HBV coinfection.