Table 3.
Hepatocellular Carcinoma Incidence in Individuals With Acquired Immunodeficiency Syndrome (AIDS), 1980–2009
| Variable | Observed Cases |
Incidence per 100,000 Person-Years |
RR [95% CI]a |
RR [95% CI]b |
SIR [95% CI] |
|---|---|---|---|---|---|
| Sex | |||||
| Males | 333 | 19.3 | 2.2 [1.5–3.2] | 2.5 [1.7–3.6] | 3.7 [3.3–4.1] |
| Females | 33 | 7.5 | Reference | Reference | 6.8 [4.7–9.5] |
| Attained age, y | |||||
| 0–29 | 3 | 1.5 | 0.3 [0.1–1.1] | Referencec | 8.6 [1.8–25] |
| 30–39 | 41 | 5.1 | Reference | Referencec | 8.5 [6.1–12] |
| 40–49 | 150 | 18.8 | 3.6 [2.6–5.2] | 3.4 [2.4–4.8] | 4.3 [3.7–5.1] |
| 50–59 | 133 | 47.3 | 9.1 [6.4–13] | 8.2 [5.8–12.0] | 3.3 [2.7–3.9] |
| ≥60 | 39 | 49.4 | 9.6 [6.2–15] | 10.0 [6.5–16.0] | 2.6 [1.9–3.6] |
| p-trend <.0001 | p-trend <.0001 | ||||
| Race/ethnicity | |||||
| Non-Hispanic white | 142 | 16.9 | Reference | Reference | 4.6 [3.8–5.4] |
| Non-Hispanic black | 165 | 18.6 | 1.3 [1.0–1.6] | 1.0 [0.8–1.2] | 3.3 [2.8–3.8] |
| Hispanic | 59 | 13.6 | 1.0 [0.7–1.3] | 0.9 [0.6–1.2[ | 4.3 [3.3–5.6] |
| HIV transmission risk group | |||||
| Non-IDU MSM | 152 | 15.7 | Reference | 3.6 [3.1–4.2] | |
| IDU | 140 | 27.7 | 1.9 [1.5–2.4] | 5.6 [4.7–6.6] | |
| IDU-MSM | 26 | 18.3 | 1.4 [0.9–2.1] | 4.4 [2.9–6.4] | |
| Hemophiliac | 7 | 88.8 | 8.2 [3.8–17.0] | 40 [16.0–83.0] | |
| Heterosexual | 20 | 6.8 | 0.6 [0.4–1.0] | 2.0 [1.2–3.1] | |
| Other/unknown | 21 | 8.5 | 0.6 [0.4–0.9] | 1.7 [1.1–2.7] | |
| HIV risk groups by HCV prevalence | |||||
| Groups with high HCV prevalence (IDU, IDU-MSM, hemophiliacs) | 173 | 26.4 | 2.1 [1.7–2.6] | 2.2 [1.8–2.8] | 5.6 [4.8–6.5] |
| Groups with low HCV prevalence (non-IDU MSM, heterosexuals, others/unknown) | 193 | 12.8 | Reference | Reference | 3.0 [2.6–3.5] |
| Attained calendar period | |||||
| 1980–1989 (pre-ART era) | 4 | 6.5 | 1.0 [0.4–2.9] | 1.1 [0.4–3.1] | 5.7 [1.6–15] |
| 1990–1995 (monotherapy/dual therapy era) | 30 | 7.0 | Reference | Reference | 3.5 [2.4–5.1] |
| 1996–2000 (early HAART era) | 118 | 14.3 | 1.7 [1.2–2.6] | 1.8 [1.2–2.6] | 3.8 [3.1–4.5] |
| 2001–2009 (recent HAART era) | 214 | 25.3 | 2.5 [1.7–3.7] | 2.7 [1.8–4.0] | 3.9 [3.4–4.5] |
| p-trend <.0001 | p-trend <.0001 | ||||
| CD4 cell count at AIDS diagnosis, cells/µLd | |||||
| 0–99 | 78 | 15.1 | Reference | 3.2 [2.5–4.0] | |
| 100–199 | 135 | 22.1 | 1.4 [1.1–1.9] | 4.7 [4.0–5.6] | |
| 200–349 | 33 | 17.2 | 1.1 [0.7–1.6] | 3.4 [2.3–4.8] | |
| ≥350 | 22 | 23.6 | 1.5 [1.0–2.5] | 5.0 [3.1–7.5] | |
| p-trend = 0.13 | |||||
| AIDS statuse | |||||
| Individuals with HIV but not AIDS | 60 | 10.1 | Reference | 2.4 [1.8–3.1] | |
| Individuals with AIDS | 36 | 26.1 | 2.4 [1.2–3.6] | 5.0 [3.5–6.9] |
Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HAART, highly active antiretroviral therapy; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IDU, injection drug users; MSM, men who have sex with men; RR, incidence rate ratio; SIR: standardized incidence ratio.
All RR estimates are adjusted for sex and age, except the RR for sex (which was adjusted for age) and age (which was adjusted for sex).
All RR estimates are from a multivariate model that included terms for sex, age, race/ethnicity, HIV risk groups by HCV prevalence, and attained calendar period. These RRs were not calculated for individual HIV risk groups, CD4 cell count strata, or strata according to AIDS status.
For this analysis, the groups ages 0 to 29 years and ages 30 to 39 years were combined into a single reference group of individuals ages 0 to 39 years.
Ninety-eight individuals with hepatocellular carcinoma were missing data on CD4 cell counts.
This analysis was restricted to individuals who initially were reported as positive for HIV infection but without AIDS and was based on data from 12 registries that provided information on these individuals.