The Role of Hepatocellular Carcinoma Surveillance in Autoimmune Hepatitis

Abstract

Type 1 autoimmune hepatitis (AIH) is a rare inflammatory disorder of the liver that may arise at any age, from infancy to adulthood. Long-standing autoimmune hepatitis may progress to cirrhosis and subsequent hepatocellular carcinoma (HCC). However, the true incidence of HCC in AIH patients is unknown as there is a paucity of published data. Currently, there are no established guidelines on screening patients with AIH for HCC. Without screening protocols, patients with AIH may present with late-stage HCC that may have been detected and treated earlier in the disease course. We describe a case of a patient with type 1 AIH who developed stage IIIB HCC in the absence of appropriate screening protocols with complex social determinants leading to barriers to access regular follow-up care.

Immunological pathways in viral hepatitis-induced hepato-cellular carcinoma

“…过去一直认为HAV感染与肝细胞癌的发展无关 ［ 15 ］ ，但统计结果显示，感染HAV会削弱患者的抵抗力，从而增加感染HCV的概率，而HCV与肝细胞癌密切相关 ［ 16 ］ 。此外，HAV能介导组织损伤，这意味着其可能可以间接促进肝细胞癌的发生 ［ 16 ］ 。研究显示，HAV相关性组织损伤并非由病毒本身直接导致，而是通过引发强烈的CD8 + T细胞免疫反应介导，非HAV特异的CD8 + T细胞、NK细胞和NKT细胞等其他免疫细胞也参与其中 ［ 8 ］ 。此外，在HAV感染小鼠模型中，由MAVS激活信号介导的固有凋亡似乎是肝炎的原因之一 ［ 17 ］ 。宿主和病毒因子的遗传变异也可以影响HAV感染的严重程度，如T细胞免疫球蛋白1和IL-18结合蛋白的基因变异与HAV感染的严重程度有关 ［ 8 ］ 。此外，HAV急性感染患者可能发展为自身免疫性肝炎，进而发展为肝硬化和肝细胞癌 ［ 18 - 19 ］ 。这些机制并不是相互排斥的，而是能单独或共同作用，导致患者肝脏损伤，增加肝细胞癌发生的潜在风险。…”

Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

“…Alcohol consumption, NAFLD and non-alcoholic steatohepatitis (NASH) are risk factors for the development of HCC with an increasing relevance [ 28 ]. Other less common causes of cirrhosis contribute to a risk of developing HCC, including primary biliary cirrhosis, autoimmune hepatitis and hemochromatosis [ 29 , 30 , 31 , 32 ]. In some regions of Asia and Africa, exposure to aflatoxin B1, due to fungal contamination of staple foods, is related to the development of mutations (TP 53 codon 249, known as TP53 R249S) that lead to the development of HCC in patients with HBV infection [ 21 , 22 , 28 , 33 ].…”

Viral Hepatitis and Hepatocellular Carcinoma: State of the Art

“…Nevertheless, the pathophysiological background of HAV-mediated tissue damage implies a potential indirect contribution to HCC, at least in specific sub-populations [18]. Relatively, patients with acute HAV infection could consequently develop autoimmune hepatitis (AIH) [22,23]; AIH can progress to liver cirrhosis and the subsequent development of HCC [24,25]. Therefore, HAV-related AIH may also potentially indirectly contribute to liver oncogenesis.…”