Incidence of liver cancer increases significantly among people with HIV
Hepatocellular carcinoma rates among people with HIV increased significantly from 1996 to 2015, according to a study published in JAMA Network Open.
The study found that people with HIV coinfected with viral hepatitis who had higher HIV RNA levels, lower CD4 cell counts, or contracted HIV through injection drug use, had a higher risk for hepatocellular carcinoma (HCC).
“HCC is among the most lethal cancers worldwide and is one of the few malignant entities with an increasing incidence and mortality in the United States in recent decades,” Jing Sun, MD, PhD, assistant scientist at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote.
“People with HIV had a more than 3 times higher [incidence rate (IR)] for HCC compared with the U.S. general population rates observed in the Surveillance, Epidemiology, and End Results-Medicare linkage (0.75 vs. 0.23 case/1000 person-years), demonstrating the increased relative burden of HCC among people with HIV,” the explained.
Sun and colleagues conducted a cohort study to examine trends of HCC rates and compare risk factors among people with HIV during the combination antiretroviral therapy era. The researchers examined rates of hepatitis B and C virus, which increase the risk for developing HCC in people with HIV. They included 109,283 people with HIV aged 18 years or older who had HIV RNA and CD4 cell count data available.
A total of 19.5% (21,343) of patients were coinfected with HCV, 5.8% (6,348) were coinfected with HBV and 1.9% (2,082) had HCV, HBV and HIV. Additionally, 451 patients were diagnosed with HCC by 2015.
Between the early combination ART (cART) era, defined as 1996 to 2000, and modern cART era, defined as 2006 to 2015, the IR of HCC increased from 0.28 to 0.75 cases per 1,000 person-years. IRs of HCC increased from 0.34 cases to 2.39 cases per 1,000 person-years in people with HIV and HCV coinfection between 1996 and 2015. HCC IRs also increased from 0.65 cases to 4.49 cases per 1,000 person-years over the same time period in individuals triple infected with HCV, HBV and HIV.
“It is vital to address other factors and health disparities to ameliorate the overall burden of HCC among aging people with HIV,” the researchers wrote. “Treatment strategies focused on HCV screening and early intervention for chronic HCV or HBV among people who inject drugs, as well as long-term management of risk behaviors, should be further explored.”