Abstract C106: Risk of hepatocellular carcinoma among people living with HIV in the United States
Authors: McGee-Avila Jennifer K. , Argirion Ilona , O’Brien Thomas R. , Engels Eric , Horner Marie-Josèphe , Luo Qianlai , Shiels Meredith 
Published: January 2023

Abstract
Background: Hepatocellular carcinoma (HCC) is the primary histological subtype of liver cancer, comprising up to 75% of such cases in the U.S. People living with HIV (PLWH) have a higher risk of HCC than the general population. A higher proportion of PLWH are coinfected with hepatitis B (HBV) or hepatitis C virus (HCV) due to shared transmission modalities such as injection drug use. Highly active antiretroviral therapy has improved survival from HIV infection, creating increased opportunities to develop liver cancer due to prolonged hepatic inflammation caused by chronic infection with HBV or HCV. Methods: We used data from the HIV/AIDS Cancer Match (HACM), a population-based HIV and cancer registry linkage in the U.S. We compared HCC risk in PLWH to the general population using standardized incidence ratios (SIRs), standardized by race/ethnicity, age group, HIV transmission risk group, calendar period, and registry. SIRs were estimated by race/ethnicity, age group, HIV transmission risk group, and calendar period. Poisson regression was used to estimate incidence rate ratios (RRs) among PLWH by race/ethnicity, age group, HIV transmission risk group and calendar period. In addition, data from Symphony Health, a Texas based health aggregator of medical claims determined the prevalence of HBV and/or HCV infection among people with HCC. Adjusted odds ratios identified predictors of HBV and HCV infection in PLWH with HCC. Results: There were 1,530 incident HCC cases from 2001–2016 in PLWH during over 4 million person-years of follow up. Compared to the general population, the overall SIR was 2.92 (95% CI 2.75-3.09). The risk of HCC was strongly elevated across all racial/ethnic and age groups. Rates were highest among NH-White PLWH (SIR 3.86; 95% CI 3.48-4.27) PLWH aged 40-49 (SIR 4.81; 95% CI 4.31-5.35) or aged 20-39 (SIR 4.15; 95% CI 2.82-5.89). Among PLWH, HCC risk was similar across racial/ethnic groups but increased with age. Compared to men who had sex with men (MSM), men who injected drugs had almost 4 times the risk of HCC (RR 3.93; 95% CI 3.38-4.55) while female PWID had a 60% increased risk (RR 1.61; 95% CI 1.28-2.01), and men with other or unknown HIV transmission had a 50% increased risk (RR 1.48; 95% CI 1.27-1.73). Between 2001-2004 and 2013-2016, rates of HCC declined 16% (RR 0.84; 95% CI 0.69-1.03). Using Symphony Health data, there were a total of 146 HCC cases, 38 coinfected with HBV, 84 with HCV, and 16 triply infected cases. Compared to MSMs, persons who inject drugs (PWID) had 85% decreased odds of HBV infection (aOR 0.15; 95% CI 0.05-0.50) and 8 times the odds of HCV infection (aOR 8.03; 95% CI 2.61-24.7). Conclusions: Utilizing recently updated population-based linked-surveillance data, we found risk of HCC has declined over time among PLWH, though rates remain significantly elevated compared to the general population, with particularly high risk among people who inject drugs. Prevention and treatment of HBV and HCV are needed to reduce HCC risk in this population.
Citation Format: Jennifer K. McGee-Avila, Ilona Argirion, Thomas R. O’Brien, Eric Engels, Marie-Josèphe Horner, Qianlai Luo, Meredith Shiels. Risk of hepatocellular carcinoma among people living with HIV in the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C106.