HSR&D Citation Abstract
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Torgersen J, Kallan MJ, Carbonari DM, Park LS, Mehta RL, D K, Tate JP, Lim JK, Goetz MB, Rodriguez-Barradas MC, Gibert CL, Bräu N, Brown ST, Roy JA, Taddei TH, Justice AC, Re VL. HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status. Journal of the National Cancer Institute. 2019 Nov 5.
Despite increasing incidence of hepatocellular carcinoma (HCC) among HIV-infected patients, it remains unclear if HIV-related factors contribute to development of HCC. We examined if higher or prolonged HIV viremia and lower CD4+ cell percentage were associated with HCC.
We conducted a cohort study of HIV-infected individuals who had HIV RNA, CD4+, and CD8+ cell counts and percentages assessed in the Veterans Aging Cohort Study (1999-2015). HCC was ascertained using Veterans Health Administration cancer registries and electronic records. Cox regression was used to determine hazard ratios (HR, 95% confidence interval [CI]) of HCC associated with higher current HIV RNA, longer duration of detectable HIV viremia ( 500 copies/mL), and current CD4+ cell percentage < 14%, adjusting for traditional HCC risk factors. Analyses were stratified by previously validated diagnoses of cirrhosis prior to start of follow-up.
Among 35,659 HIV-infected patients, 302 (0.8%) developed HCC over 281,441 person-years (incidence rate, 107.3/100,000 person-years). Among patients without baseline cirrhosis, higher HIV RNA (HR = 1.25 [95%CI = 1.12-1.40] per 1.0 log10 copies/mL) and 12 months of detectable HIV (HR = 1.47 [95%CI = 1.02-2.11]) were independently associated with higher risk of HCC. CD4+ percentage < 14% was not associated with HCC in any model. Hepatitis C coinfection was a statistically significant predictor of HCC regardless of baseline cirrhosis status.
Among HIV-infected patients without baseline cirrhosis, higher HIV RNA and longer duration of HIV viremia increased risk of HCC, independent of traditional HCC risk factors. This is the strongest evidence to date that HIV viremia contributes to risk of HCC in this group.