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HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status.
- Source :
-
Journal of the National Cancer Institute [J Natl Cancer Inst] 2020 Jul 01; Vol. 112 (7), pp. 747-755. - Publication Year :
- 2020
-
Abstract
- Background: 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.<br />Methods: 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 less than 14%, adjusting for traditional HCC risk factors. Analyses were stratified by previously validated diagnoses of cirrhosis prior to start of follow-up.<br />Results: Among 35 659 HIV-infected patients, 302 (0.8%) developed HCC over 281 441 person-years (incidence rate = 107.3 per 100 000 person-years). Among patients without baseline cirrhosis, higher HIV RNA (HR = 1.25, 95% CI = 1.12 to 1.40, per 1.0 log10 copies/mL) and 12 or more months of detectable HIV (HR = 1.47, 95% CI = 1.02 to 2.11) were independently associated with higher risk of HCC. CD4+ percentage less than 14% was not associated with HCC in any model. Hepatitis C coinfection was a statistically significant predictor of HCC regardless of baseline cirrhosis status.<br />Conclusion: 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.<br /> (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Adult
CD4-Positive T-Lymphocytes pathology
CD8-Positive T-Lymphocytes pathology
Carcinoma, Hepatocellular immunology
Carcinoma, Hepatocellular virology
Cohort Studies
Female
HIV genetics
HIV immunology
HIV Infections blood
HIV Infections immunology
HIV Infections virology
Humans
Liver Cirrhosis immunology
Liver Cirrhosis virology
Liver Neoplasms immunology
Liver Neoplasms virology
Male
Middle Aged
RNA, Viral
Retrospective Studies
United States epidemiology
United States Department of Veterans Affairs
Veterans
Viremia epidemiology
Viremia immunology
Viremia virology
CD4-Positive T-Lymphocytes immunology
CD8-Positive T-Lymphocytes immunology
Carcinoma, Hepatocellular epidemiology
HIV Infections epidemiology
Liver Cirrhosis epidemiology
Liver Neoplasms epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2105
- Volume :
- 112
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of the National Cancer Institute
- Publication Type :
- Academic Journal
- Accession number :
- 31687755
- Full Text :
- https://doi.org/10.1093/jnci/djz214