Presentation, treatment and long-term outcomes of hepatocellular carcinoma in patients with and without HIV: a comparative observational cohort study.

Background: This study explores the epidemiology, treatment and outcomes of hepatocellular carcinoma (HCC) in a sub-Saharan cohort, comparing patients with and without human immunodeficiency virus (HIV).

Methods: A retrospective cohort study of patients treated for HCC from 1 February 2011 to 29 February 2024 at Groote Schuur Hospital, South Africa was performed.

Results: Of the 501 HCC patients, 75 (15.0 %) were people living with HIV (PLWH). The PLWH were younger (43.7 ± 9.7 vs. 52.9 ± 15.3 years, p < 0.00001), had more frequent chronic hepatitis B virus (HBV) co-infection (85.3 % vs. 51.6 %, p < 0.00001) and no hepatitis C virus co-infection (0 % vs. 6.8 %, p = 0.013). More PLWH presented with Barcelona Clinic Liver Cancer Stage D disease (43.6 % vs. 27.7 %, p = 0.007). Similar proportions of PLWH and HIV-negative patients received curative-intended treatments, life-prolonging therapies and best supportive care. In PLWH, the median survival was lower (44 [IQR: 16-163.7] vs. 78 [IQR: 26-191] days, p = 0.010), and patients with HIV-HBV co-infection had the lowest survival (39 [IQR: 14.7-155.2] days).

Conclusions: In a sub-Saharan HCC cohort, patients with HIV were significantly younger, had more advanced disease and HBV co-infection resulted in the lowest survival. Earlier detection through aggressive HCC screening is key to improving outcomes in PLWH.