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 and AimsPeople 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.MethodsIn 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).ResultsThe 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).ConclusionAmong 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.