The Effect of HIV Viral Control on the Incidence of Hepatocellular Carcinoma in Veterans With Hepatitis C and HIV Coinfection

Abstract

Background HIV increases the risk of progression to hepatic fibrosis and cirrhosis among individuals coinfected with hepatitis C virus (HCV). However, the impact of HIV-related immune suppression on the risk of hepatocellular carcinoma (HCC) is currently unknown. Methods We used the VA HIV Clinical Case Registry to identify patients with HIV infection between 1985 and 2010 and HCV coinfection (positive HCV RNA or genotype test) between 1995 and 2010. The outcome was incident HCC as indicated by ICD-9 code (87% positive predictive value). Patients with HCV monoinfection were included as a comparison group for HCC incidence. Age-adjusted HCC incidence rates were calculated for the coinfected cohort and HCV monoinfected cohort. Cox proportional hazards models were used to determine hazard ratios (HR) and 95% confidence intervals (CI) for each risk factor on the time to HCC diagnosis in the coinfected cohort. Results There were 66,991 veterans with HIV; 8,563 had at least one positive HCV RNA test, and 234 of these developed HCC. The overall age-adjusted incidence rate of HCC in monoinfected patients was 2.99/1000 PY vs. 4.44/1000 PY in coinfected patients. In patients with coinfection, presence of cirrhosis (HR=4.88; 95%CI: 3.30–7.21), HIV diagnosis >2002 (HR=4.65; 95%CI: 2.70–8.02), and a recent low CD4+ cell count <200 (HR=1.71; 95%CI: 1.20–2.45) were associated with an increased risk for HCC. Conclusions The risk of HCC in HCV-HIV coinfected veteran men was higher than HCV monoinfection. Diagnosis of cirrhosis and low recent CD4+ cell count were the most important predictors of developing HCC in this group.

Liver‐related mortality and hospitalizations attributable to chronic hepatitis C virus coinfection in persons living with HIV

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Statin drugs decrease progression to cirrhosis in HIV/hepatitis C virus coinfected individuals

“…[27] The original cohort has been previously described in detail. [12] Figure 1 shows the additional restrictions made to the original cohort, which resulted in the final cohort used for these analyses. This study was approved by the Institutional Review Board of Baylor College of Medicine and Affiliated Institutions and the Michael E. DeBakey VA Medical Center Research and Development Committee.…”

Human immunodeficiency virus and liver disease: A comprehensive update

“…Both the incidence and prevalence of HCC appears to be increasing in patients with HIV infection . The increase in HCC may represent a complex mix of altered natural history changing epidemiology and ascertainment bias.…”