Trends in Incidences and Risk Factors for Hepatocellular Carcinoma and Other Liver Events in HIV and Hepatitis C Virus-coinfected Individuals From 2001 to 2014: A Multicohort Study

Abstract

Background: While liver-related deaths in human immunodeficiency virus (HIV) and hepatitis C virus (HCV)-coinfected individuals have declined over the last decade, hepatocellular carcinoma (HCC) may have increased. We describe the epidemiology of HCC and other liver events in a multicohort collaboration of HIV/HCV-coinfected individuals.

Methods: We studied HCV antibody-positive adults with HIV in the EuroSIDA study, the Southern Alberta Clinic Cohort, the Canadian Co-infection Cohort, and the Swiss HIV Cohort study from 2001 to 2014. We calculated the incidence of HCC and other liver events (defined as liver-related deaths or decompensations, excluding HCC) and used Poisson regression to estimate incidence rate ratios.

Results: Our study comprised 7229 HIV/HCV-coinfected individuals (68% male, 90% white). During follow-up, 72 cases of HCC and 375 other liver events occurred, yielding incidence rates of 1.6 (95% confidence interval [CI], 1.3, 2.0) and 8.6 (95% CI, 7.8, 9.5) cases per 1000 person-years of follow-up, respectively. The rate of HCC increased 11% per calendar year (95% CI, 4%, 19%) and decreased 4% for other liver events (95% CI, 2%, 7%), but only the latter remained statistically significant after adjustment for potential confounders. Older age, cirrhosis, and low current CD4 cell count were associated with a higher incidence of both HCC and other liver events.

Conclusions: In HIV/HCV-coinfected individuals, the crude incidence of HCC increased from 2001 to 2014, while other liver events declined. Individuals with cirrhosis or low current CD4 cell count are at highest risk of developing HCC or other liver events.

Keywords: HIV; cohort study; hepatitis C virus; hepatocellular carcinoma; liver disease.

Figure 1.

Trend in incidence rates (with 95% confidence intervals [CI]) of hepatocellular carcinoma (HCC) and other liver events in 7229 human immunodeficiency virus/hepatitis C virus coinfected individuals from 2001 to 2014. Abbreviations: IR, incidence rate; OLE, other liver event.

Figure 2.

Incidence rates (with 95% confidence intervals) for hepatocellular carcinoma and other liver events in human immunodeficiency virus/hepatitis C virus coinfected individuals stratified by cirrhosis status and current CD4 cell count (cells/mm³). Note: Formal analysis of interaction between cirrhosis and current CD4 cell count was not significant for both outcomes (all P values >.2).

Figure 3.

Adjusted incidence rate ratios (with 95% confidence intervals) for a selection of risk factors for hepatocellular carcinoma and other liver events in multivariate time-updated Poisson regression models. Abbreviations: BMI, body mass index; cART, combination antiretroviral therapy; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus.