Risk of HCC With Hepatitis B Viremia Among HIV/HBV-Coinfected Persons in North America.

Abstract

BACKGROUND AND AIMS:

Chronic HBV is the predominant cause of HCC worldwide. Although HBV coinfection is common in HIV, the determinants of HCC in HIV/HBV coinfection are poorly characterized. We examined the predictors of HCC in a multicohort study of individuals coinfected with HIV/HBV.

APPROACH AND RESULTS:

We included persons coinfected with HIV/HBV within 22 cohorts of the North American AIDS Cohort Collaboration on Research and Design (1995-2016). First occurrence of HCC was verified by medical record review and/or cancer registry. We used multivariable Cox regression to determine adjusted HRs (aHRs [95% CIs]) of factors assessed at cohort entry (age, sex, race, body mass index), ever during observation (heavy alcohol use, HCV), or time-updated (HIV RNA, CD4+ percentage, diabetes mellitus, HBV DNA). Among 8,354 individuals coinfected with HIV/HBV (median age, 43 years; 93% male; 52.4% non-White), 115 HCC cases were diagnosed over 65,392 person-years (incidence rate, 1.8 [95% CI, 1.5-2.1] events/1,000 person-years). Risk factors for HCC included age 40-49 years (aHR, 1.97 [1.22-3.17]), age ≥50 years (aHR, 2.55 [1.49-4.35]), HCV coinfection (aHR, 1.61 [1.07-2.40]), and heavy alcohol use (aHR, 1.52 [1.04-2.23]), while time-updated HIV RNA >500 copies/mL (aHR, 0.90 [0.56-1.43]) and time-updated CD4+ percentage <14% (aHR, 1.03 [0.56-1.90]) were not. The risk of HCC was increased with time-updated HBV DNA >200 IU/mL (aHR, 2.22 [1.42-3.47]) and was higher with each 1.0 log10 IU/mL increase in time-updated HBV DNA (aHR, 1.18 [1.05-1.34]). HBV suppression with HBV-active antiretroviral therapy (ART) for ≥1 year significantly reduced HCC risk (aHR, 0.42 [0.24-0.73]).

CONCLUSION:

Individuals coinfected with HIV/HBV on ART with detectable HBV viremia remain at risk for HCC. To gain maximal benefit from ART for HCC prevention, sustained HBV suppression is necessary.

• Authors: H Nina Kim, Craig W Newcomb, Dena M Carbonari, Jason A Roy, Jessie Torgersen, Keri N Althoff, Mari M Kitahata, K Rajender Reddy, Joseph K Lim, Michael J Silverberg, Angel M Mayor, Michael A Horberg, Edward R Cachay, Gregory D Kirk, Jing Sun, Mark Hull, M John Gill, Timothy R Sterling, Jay R Kostman, Marion G Peters, Richard D Moore, Marina B Klein, Vincent Lo Re 3rd, North American AIDS Cohort Collaboration on Research, Design of IeDEA
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 74 Issue 3 Pg. 1190-1202 (09 2021) ISSN: 1527-3350 [Electronic] United States
• PMID: 33780007 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © 2021 by the American Association for the Study of Liver Diseases.

Topics

• Adult
• Age Factors
• Alcoholism (epidemiology)
• Carcinoma, Hepatocellular (epidemiology)
• Coinfection
• Female
• HIV Infections (epidemiology)
• Hepatitis B, Chronic (epidemiology)
• Hepatitis C, Chronic (epidemiology)
• Humans
• Liver Neoplasms (epidemiology)
• Male
• Middle Aged
• Multivariate Analysis
• North America
• Proportional Hazards Models
• Risk Assessment
• Risk Factors
• Viremia (epidemiology)