Occurrence of cholangiocarcinoma after AIDS-related cholangitis

Abstract number: 1135_246

Charlier C., Lecuit M., Furco A., Estavoyer J.M., Lafeuillade A., Dupont B., Lortholary O., Viard J.P.

Objective:  

Increased survival among patients with AIDS has led to a recent increase of neoplasms. Cholangiocarcinoma (CC) is a rare form of malignancy arising from the bile duct epithelium, that may be associated with history of chronic inflammation of the biliary tract. We describe here the first series of five patients with AIDS-associated CC.

Methods:  

Retrospective multicentric study among all 54 Departments of Infectious Diseases of French University Hospitals.

Results:  

All patients were men of Caucasian origin. At CC diagnosis, median age was 48 yrs (range 38–61 yrs), median known duration of HIV infection was 13 years (range 0–17). Four patients were at CDC stage C of infection, with a median time between AIDS and CC diagnoses of 13 years (0–17). Three patients were treated by HAART with a median duration of 1 year (range 0–8 years). Median CD4+ lymphocyte count was 170/mm³ (range 1–600/mm³) and median viral load was 32,000 copies RNA/ml (range <50–47, 700). All five patients were lacking the most important risk factors for CC (sclerosing cholangitis and liver fluke infection), but three had an history of AIDS-related cholangitis (including one related to cytomegalovirus). Median survival was 7.5 months (range 2 month-9 yrs). Only one patient could have complete tumour resection with prolonged survival (9 years).

Conclusions:  

1. Patients with AIDS may develop CC, especially those with long lasting infection and previous AIDS-related cholangitis; 2. Patients with history of AIDS-related cholangitis should therefore be closely monitored, since early diagnosis is key for surgical excision which is associated with increased survival.