Incidence of and Factors Associated with Hepatocellular Carcinoma among Hepatitis C Virus and Human Immunodeficiency Virus Coinfected Patients with Decompensated Cirrhosis

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Abstract
We compared the incidence of and factors associated with hepatocellular carcinoma (HCC) among hepatitis C virus (HCV)-monoinfected subjects and human immunodeficiency virus (HIV)/HCV-coinfected individuals, both with decompensated cirrhosis. In a retrospective study, a cohort of 180 individuals with HIV coinfection and 1037 HCV-monoinfected patients with decompensated HCV-related cirrhosis from eight centres in Spain were analyzed. HCC was found in 234 (23%) HCV-monoinfected subjects and in four (2%) HIV-coinfected subjects (p < 0.001). At the time of the first hepatic decompensation, 188 (17%) and 4 (2%) (p < 0.001) patients in the former and in the latter group, respectively, showed HCC. Fifty-four (11%) patients without HCC at baseline developed such a disease during follow-up. There were no incident cases among the HIV-coinfected population. The density of incidence (95% IC) of HCC in HIV/HCV-coinfected and HCV-monoinfected patients was 0 (0–1.70) and 3.31 (2.70–4.64) cases per 100 person-years (p < 0.001), respectively. Lack of HIV infection [adjusted odds risk (AOR) (95% IC) = 16.7 (3.9–71.1)] and high alanine aminotransferase levels [AOR (95% IC) = 2.5 (1.1–5)] were the only two independent predictors of the emergence of HCC. In the group of patients in whom the date of HCV infection could be estimated, the time elapsed until HCC diagnosis was shorter among HIV-coinfected subjects. The incidence of HCC in patients with HCV-related cirrhosis after the first hepatic decompensation is lower in HIV-coinfected patients. This is probably due to the fact that HIV infection shortens the survival of HCV-coinfected patients with end-stage liver disease to such an extent that HCC not had a chance to emerge.