Hepatocellular Carcinoma Survival in People With and Without HIV in the United States, 2001–2019

BACKGROUND: Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood. METHODS: We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001-2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH. RESULTS: A total of 71 516 cases of HCC including 1610 PWH occurred during 2001-2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27-1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01-1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001-2003 to 2016-2019 (Ptrends & .0002 and .06, respectively). CONCLUSIONS: HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.