Are HIV (Human Immunodeficiency Virus) patients prone to liver cancer?

HIV Patients and Liver Cancer Risk

Yes, HIV patients are at increased risk of developing liver cancer (hepatocellular carcinoma) compared to the general population, with approximately 2.79-fold higher rates. 1

Epidemiology and Risk Factors

• HIV appears to be an additive co-factor that increases the risk of hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis 2
• The incidence of HCC is higher among patients with HIV infection than in the general population 2
• In 2010, liver cancer represented approximately 5% of all incident cancer cases among people living with HIV in the United States 2
• HIV-positive HCC patients tend to be younger (average 52 vs. 64 years) and more frequently symptomatic than HIV-negative patients 3

Mechanisms of Increased Risk

• HIV-induced immune deficiency is a key factor in HCC development, with current CD4+ counts below 500 cells/mm³ independently associated with a higher risk of hepatocarcinoma (HR: 10.3) 4
• The risk appears to be independent of the cumulative duration of immunodeficiency, suggesting that improving CD4+ counts through antiretroviral therapy may decrease HCC risk regardless of how long a patient has been immunosuppressed 4
• HIV infection may accelerate the progression of liver disease in patients co-infected with hepatitis viruses 3

Co-infection with Viral Hepatitis

• The increased risk of HCC in HIV patients is largely driven by higher rates of co-infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) 1
• In a Texas study of HIV patients with HCC, 25% were HBV positive, 59% were HCV positive, and 13% were co-infected with both HBV and HCV 1
• HCC develops faster in HIV/HCV-coinfected patients than in HCV-monoinfected patients (mean 26 vs. 34 years after HCV infection) 3
• Triple infection with HIV, HBV, and HDV (hepatitis delta virus) is associated with a 6- to 9-fold increase in HCC risk compared to HIV/HBV co-infection alone 2

Risk Stratification in HIV Patients

• People who inject drugs and have HIV face the highest risk of HCC, with 4.28-fold higher risk in men and 1.83-fold higher risk in women compared to men who have sex with men 1
• HIV patients with cirrhosis from any cause should undergo HCC surveillance 2
• HIV patients with chronic hepatitis B or C should be monitored for HCC according to the same criteria as mono-infected patients, based on the stage and grade of liver disease 2

Surveillance Recommendations

• All HIV patients with cirrhosis, regardless of cause, should undergo HCC surveillance with ultrasound every 6 months 2
• HIV patients with chronic HBV infection should begin surveillance at age 40 for Asian men and age 50 for Asian women, while African patients may need to start at a younger age due to earlier HCC development 2
• For Caucasian HIV patients with HBV, surveillance is recommended for those with cirrhosis or active hepatitis even without cirrhosis 2

Management Considerations

• HIV-positive HCC patients should be co-managed by an oncologist and HIV specialist 2
• Antiretroviral therapy should be continued during cancer therapy, though modifications may be needed 2
• In untreated HIV patients with HCC, undetectable HIV viral load (<400 copies/mL) is associated with longer survival (6.5 vs. 2.6 months) 3

Prevention Strategies

• Prevention and treatment of HBV/HCV are crucial to reduce HCC risk among people with HIV 1
• Universal vaccination against HBV is recommended for all newborns and high-risk groups to prevent HBV-related HCC 2
• Effective antiretroviral therapy that maintains CD4+ counts above 500 cells/mm³ may help reduce HCC risk in HIV patients 4