The first 2 authors contributed equally to this work.
Article first published online: 26 JUN 2012
Published 2012 American Cancer Society
Volume 118, Issue 24, pages 6226–6233, 15 December 2012
How to Cite
Sahasrabuddhe, V. V., Shiels, M. S., McGlynn, K. A. and Engels, E. A. (2012), The risk of hepatocellular carcinoma among individuals with acquired immunodeficiency syndrome in the United States. Cancer, 118: 6226–6233. doi: 10.1002/cncr.27694
The authors thank the HIV/AIDS and cancer registry staff in the following states and metropolitan areas for contributing data to the study: 14 registries for data on individuals with AIDS (the state registries of California, Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, and Texas; and registries in the metropolitan areas of New York, NY; Seattle, WA; and Washington, DC) and 12 registries for data on individuals with HIV infection in the absence of AIDS (the state registries of Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, Michigan, New Jersey, and Texas; and registries in the metropolitan areas of Los Angeles, CA; Seattle, WA; and Washington, DC). The authors also thank Tim McNeel (Information Management Systems) for database management.
This article is US Government work and, as such, is in the public domain in the United States of America.
- Issue published online: 3 DEC 2012
- Article first published online: 26 JUN 2012
- Manuscript Accepted: 8 MAY 2012
- Manuscript Revised: 2 MAY 2012
- Manuscript Received: 5 MAR 2012
- hepatocellular carcinoma;
- human immunodeficiency virus;
- acquired immunodeficiency syndrome;
- hepatitis C virus
Hepatocellular carcinoma (HCC) is a concern among individuals with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).
The authors analyzed population-based registry linkage data from the US HIV/AIDS Cancer Match Study (1980-2009) to examine the risk and trends of HCC among individuals with AIDS. Standardized incidence ratios (SIRs) were used to measure HCC risk relative to the general population, and Poisson regression was used to calculate incidence rate ratios (RR) comparing incidence among individuals with AIDS. People with AIDS were categorized according to their HIV risk group into high and low hepatitis C virus (HCV) prevalence groups based on their HIV transmission risk category.
Among 615,150 individuals with AIDS, HCC risk was elevated almost 4 times compared with the risk in the general population (N = 366; SIR, 3.8; 95% confidence interval, 3.5-4.3). Although HCC incidence increased steadily across calendar periods (Ptrend < .0001; adjusted for sex and age), the excess risk in individuals with AIDS compared with the general population remained somewhat constant (SIRs range, 3.5-3.9) between the monotherapy/dual therapy era (1990-1995) and the recent highly active antiretroviral therapy era (2001-2009). In a multivariate model adjusting for sex, race/ethnicity, and attained calendar period, HCC incidence increased with advancing age (Ptrend < .0001) and was associated with HIV risk groups with a known higher prevalence of HCV (adjusted RR, 2.2; 95% confidence interval, 1.8-2.8).
HCC incidence in individuals with AIDS has increased over time despite improved HIV treatment regimens, likely reflecting prolonged survival with chronic liver disease. The high incidence in older adults suggests that this cancer will increase in importance with aging of the HIV-infected population. Cancer 2012. Published 2012 by the American Cancer Society.