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Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma

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Objective

To investigate HIV-related immunodeficiency as a risk factor for hepatocellular carcinoma (HCC) among persons infected with HIV, whilst controlling for the effect of frequent co-infection with hepatitis C and hepatitis B viruses.

Design

A case-control study nested in the Swiss HIV Cohort Study (SHCS).

Methods

Twenty-six HCC cases were identified in the SHCS or through linkage with Swiss Cancer Registries, and were individually matched to 251 controls by SHCS centre, gender, HIV-transmission category, age and year at enrolment. Odds ratios (OR) and corresponding confidence intervals (CI) were estimated by conditional logistic regression.

Results

All cases and 53 percent of controls (92% of controls among intravenous drug users [IDU]) were positive for hepatitis B superficial antigen (HBsAg) or antibodies against HCV (anti-HCV). HCC cases included 14 IDU (three positive for HBsAg, 13 for anti-HCV), and 12 men having sex with men (MSM)/heterosexual/others (11 positive for HBsAg, three for anti-HCV), revealing a strong relationship between HIV transmission route and hepatitis viral type. Latest CD4+ cell count was significantly associated with HCC (OR for lowest versus highest tertile = 4.26, 95% CI: 1.18–15.5). This effect was concentrated among MSM/heterosexual/others (OR = 18.2, 95% CI: 1.61–207) rather than IDU (OR = 1.79, 95% CI: 0.39–8.23). HAART use was not significantly associated with HCC risk (OR for ever versus never = 0.59, 95% CI: 0.18–1.91).

Conclusion

More than CD4+ cell counts increased the risk for HCC among persons infected with HIV, an effect that was particularly evident for HBV-related HCC arising in non-IDUs.

Author information

Correspondence to GM Clifford.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Hepatitis
  • Hepatocellular Carcinoma
  • Drug User
  • Conditional Logistic Regression
  • Transmission Route