Risk of hepatocellular carcinoma in people with HIV in the United States, 2001-2019

Abstract

Background People with HIV (PWH) have higher risk of hepatocellular carcinoma (HCC) than the general population, partly due to higher prevalence of coinfection with hepatitis B virus (HBV) or C virus (HCV). Methods We calculated standardized incidence ratios for HCC in PWH by comparing rates from PWH in the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage, to those in the general population. We used multivariable Poisson regression to estimate adjusted incidence rate ratios (aIRRs) among PWH and linked the Texas HIV registry with medical claims data to estimate adjusted odds ratios (aORs) of HBV and HCV in HCC cases with logistic regression. Results Compared to the general population, HCC rates in PWH were elevated 2.79-fold (n = 1,736; 95%CI 2.66-2.92). HCC rates decreased significantly from 2001-2004 to 2015-2019 (p < 0.001). Compared to men who had sex with men (MSM), HCC risk was elevated 4.28-fold among men who injected drugs (95%CI 3.72-4.93) and 1.83-fold among women who injected drugs (95%CI 1.49-2.26). In Texas, 146 HCC cases amongst PWH were linked to claims data; 25% HBV-positive, 59% HCV-positive, and 13% co-infected with HBV and HCV. Compared to MSM, people who inject drugs (PWID) had 82% decreased odds of HBV (aOR 0.18; 95%CI (0.05 – 0.63), and 2-times the odds of HCV (aOR 20.4; 95%CI 3.32-125.3). Conclusions During 2001-2019, HCC risk declined among PWH, though rates remain significantly elevated compared to the general population, particularly among PWID. Prevention and treatment of HBV/HCV are needed to reduce HCC risk among PWH.

Commentary: Case Report: Lenvatinib for the treatment of recurrent hepatocellular carcinoma in people living with HIV: a report of two cases

“…Although higher HCC incidence risk was reported among people living with HIV (PLWH) compared to general population, it actually declined from 2001 to 2019 (1), especially among cases with tenofovir (TDF) usage (2). However, poor adherence to HCC screening (3), delayed HCC diagnosis (4) and scarce data about tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) (5) were observed among HIV/HBV or HIV/HCV patients.…”