Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa:a focus on surveillance

Human immunodeficiency virus(HIV)and hepatitis-B virus(HBV)infections are weighty public health challenges,especially in the African continent.The direct carcinogenic effect of HBV means that it remains a potent cause of early-onset hepatocellular carcinoma(HCC)in Sub-Saharan Africa(SSA),where it causes significant morbidity and mortality.The presence of HIV infection in HBV-infected patients poses a complicating factor,as coinfection has been shown to hasten the progression of liver disease to cirrhosis and HCC,and often resulting in early-age hepatocarcinogenesis with consequent late diagnosis and lower survival.In this review,we discuss this unique conundrum,the epidemiology of HIV-HBV coinfection in SSA,its effect on liver disease and development of HCC,as well as practices and barriers to HCC surveillance in this distinct population.We propose a way forward to curb this considerable health burden focusing on reduction of disease stigma,the need for easy-to-measure biomarkers,and implementation of large prospective studies in this population.

Nine-month angiographic and two-year clinical follow-up of polymer-free sirolimus-eluting stent versus durable-polymer sirolimus-eluting stent for coronary artery disease： the Nano randomized trial

Background First generation drug-eluting stents （DES） were associated with a high incidence of late stent thrombosis （ST）,mainly due to delayed healing and re-endothelization by the durable polymer coating.This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent （SES） in the treatment of patients with de novo coronary artery lesions.Methods The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES （Lepu Medical Technology,Beijing,China） in the treatment of patients with de novo native coronary lesions.The primary endpoint was in-stent late lumen loss （LLL） at 9-month follow-up.The secondary endpoint was major adverse cardiac events （MACE）,a composite of cardiac death,myocardial infarction or target lesion revascularization.Results A total of 291 patients （Nano group：n=143,Partner group：n=148） were enrolled in this trial from 19 Chinese centers.The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months （P 〈0.001）.The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES （0.34±0.42） mm vs.（0.30±0.48） mm,P=0.21）.The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% （P=0.75） at 2 years follow-up.The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES （0.8% vs.0.7%,0.8% vs.1.5%,both P=1.00）.Conclusions In this multicenter randomized Nano trial,the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions.Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.