Among PLWH, the incidence of hepatocellular carcinoma (HCC) rose significantly from the early antiretroviral era (1996-2000) to the modern antiretroviral era (2006-2015), a study published in JAMA Network Open found.
Data for the current study came from the longitudinal NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) cohort and included 109,283 PLWH with 723,441 person-years of follow-up. At baseline, 85% of participants were male, 41% identified as Black, and the median age was 43 years. Twenty percent of participants were coinfected with hepatitis C, 6% with hepatitis B, and 2% with both HCV and HBV.
By 2015, 451 people had been diagnosed with HCC, for an incidence of 0.28/1,000 person-years in the early period and 0.75/1,000 PY in the later period. The increase was driven by people co-infected with HCV, since incidence remained constant among those living only with HIV or with HIV/HBV.
Barriers to HCV treatment with direct-acting antivirals include the high cost of the medications, the study authors noted. “Appreciating the substantial risk associated with HIV-HCV coinfection and the public health burden, access to hepatitis C treatment among PWH should be prioritized,” they recommended.
During 2006-2015, recent HIV RNA ≥ 500 copies/mL was also associated with higher HCC risk compared to participants with well-controlled HIV. Greater HCC risk was also seen among people who inject drugs compared to MSM—a finding that could only be partly explained by higher viral hepatitis rates among people using substances.
Health disparities also play a role in HCC rate differences across risk groups and need to be addressed, study authors urged. “These findings underscore the importance of achieving immune recovery and monitoring for and long-term management of viral hepatitis among [PLWH],” they concluded.