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.
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.



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.



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.



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.
Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Lars I
LI
Gjærde
Department of Infection and Population Health, University College London, United Kingdom.
Leah
L
Shepherd
Department of Infectious Diseases and Hepatology, Medical University of Lodz, Poland.
Elzbieta
E
Jablonowska
Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
Adriano
A
Lazzarin
Division of Infectious Diseases, University Hospital Geneva.
Mathieu
M
Rougemont
Service of Infectious Diseases, Lausanne University Hospital.
Katharine
K
Darling
Divisions of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel.
Manuel
M
Battegay
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
Dominique
D
Braun
Department of Microbiology and Infectious Diseases, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
Valerie
V
Martel-Laferriere
Centre for Health & Infectious Disease Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark.
Jens D
JD
Lundgren
University of Bonn, Germany.
Jürgen K
JK
Rockstroh
Department of Medicine, University of Calgary, Alberta, Canada.
John
J
Gill
Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Andri
A
Rauch
Department of Infection and Population Health, University College London, United Kingdom.
Amanda
A
Mocroft
Department of Medicine, Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada.
Marina B
MB
Klein
Centre for Health & Infectious Disease Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark.
Lars
L
Peters
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D060085:Coinfection / Q000150:complications / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology*; D008297:Male; D012307:Risk Factors
HIV; cohort study; hepatitis C virus; hepatocellular carcinoma; liver disease