Lower incidence of HCC and other major adverse liver outcomes in people living with HIV and chronic liver disease: a population-based cohort study

Background People living with HIV (PLWH) show a high incidence of chronic liver disease (CLD). However, whether HIV is associated with major adverse liver outcomes (MALO) in patients with underlying CLD remains to be determined.

Methods In this population-based cohort study, data were retrieved from the Swedish National Patient Register to identify PLWH and CLD (n=2,375) or CLD without HIV (n=144,346) between 1997 and 2020. The cumulative incidence of MALO was calculated while accounting for competing risks (non-MALO death). Incidence rates per 1000 person-years were compared between the exposure groups (HIV vs. no HIV) with Cox regression to estimate adjusted hazard ratios (HR) and their 95% confidence intervals (CIs).

Results The incidence rate per 1000 person-years of MALO was lower in PLWH (5.1, 95% CI 4.2-6.1) compared to patients without HIV (13.1, 95% CI 12.9-13.3). This translated into an adjusted HR of 0.77 (95% CI 0.64-0.93), driven by a lower rate of hepatocellular carcinoma (adjusted HR=0.61, 95% CI 0.43-0.86). Consistent results were noted across a range of subgroup analyses. The 10-year cumulative incidence of MALO was lower in PLWH (5.0%, 95% CI 4.1-6.1) than in patients without HIV (10.9%, 95% CI 10.7-11.0).

Conclusion Among patients with CLD, the risk of MALO was lower in PLWH compared to those without HIV, primarily due to a lower incidence of HCC. These results suggest that HIV is not associated with a higher risk of MALO.

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Artikel online veröffentlicht:
23. Januar 2024