Table 2.
Factors associated with hepatocellular carcinoma among HIV/hepatitis B virus-coinfected persons in the North American AIDS Cohort Collaboration on Research and Design (1995–2016; n=8,354; 115 incident hepatocellular carcinoma events identified).
| Characteristic | No. Exposed* | No. Events | Person-Time | Incidence Rate (95% CI), Events/1,000 Person-Years | Unadjusted HR (95% CI) | Adjusted HR† (95% CI) |
|---|---|---|---|---|---|---|
| Age | ||||||
| <40 years | 3,224 | 25 | 26,141 | 1.0 (0.6–1.4) | Reference | Reference |
| 40–49 years | 3,204 | 56 | 26,221 | 2.1 (1.6–2.8) | 2.21 (1.38–3.54) | 1.97 (1.22–3.17) |
| ≥50 years | 1,926 | 34 | 13,029 | 2.6 (1.8–3.6) | 2.82 (1.68–4.73) | 2.55 (1.49–4.35) |
| Sex | ||||||
| Female | 579 | 3 | 4,364 | 0.7 (0.1–2.0) | Reference | Reference |
| Male | 7,775 | 112 | 61,028 | 1.8 (1.5–2.2) | 2.61 (0.83–8.21) | 1.92 (0.60–6.14) |
| Race | ||||||
| Non-white | 4,381 | 51 | 33,540 | 1.5 (1.1–2.0) | Reference | Reference |
| White | 3,973 | 64 | 31,852 | 2.0 (1.5–2.6) | 1.30 (0.90–1.88) | 1.38 (0.94–2.03) |
| Body mass index | ||||||
| Not obese (<30 kg/m2) | 6,749 | 95 | 54,954 | 1.7 (1.4–2.1) | Reference | Reference |
| Obese (≥30 kg/m2) | 929 | 12 | 7,218 | 1.7 (0.9–2.9) | 0.98 (0.54–1.79) | 1.00 (0.55–1.83) |
| Time-updated diabetes mellitus ‡ | ||||||
| No | 7,903 | 104 | 62,138 | 1.7 (1.4–2.0) | Reference | Reference |
| Yes | 449 | 11 | 3,253 | 3.4 (1.7–6.1) | 2.08 (1.12–3.87) | 1.79 (0.95–3.38) |
| Heavy alcohol use § | ||||||
| No | 5,207 | 51 | 36,804 | 1.4 (1.0–1.8) | Reference | Reference |
| Yes | 2,946 | 63 | 27,103 | 2.3 (1.8–3.0) | 1.62 (1.12–2.35) | 1.52 (1.04–2.23) |
| Chronic hepatitis C virus infection || | ||||||
| No | 6,551 | 75 | 50,504 | 1.5 (1.2–1.9) | Reference | Reference |
| Yes | 1,803 | 40 | 14,888 | 2.7 (1.9–3.7) | 1.79 (1.22–2.63) | 1.61 (1.07–2.40) |
| Time-updated HIV RNA | ||||||
| ≤500 copies/mL | 7,436 | 87 | 45,829 | 1.9 (1.5–2.3) | Reference | Reference |
| >500 copies/mL | 6,719 | 28 | 19,563 | 1.4 (1.0–2.1) | 0.89 (0.57–1.37) | 0.90 (0.56–1.43) |
| Time-updated CD4+ cell percentage | ||||||
| >28% | 4,961 | 40 | 25,873 | 1.5 (1.1–2.1) | Reference | Reference |
| 14–28% | 6,219 | 59 | 27,469 | 2.1 (1.6–2.8) | 1.47 (0.98–2.21) | 1.47 (0.97–2.21) |
| <14% | 3,973 | 16 | 12,049 | 1.3 (0.8–2.2) | 0.98 (0.55–1.76) | 1.03 (0.56–1.90) |
| Year at start of follow-up (per year) | .. | .. | .. | .. | 0.96 (0.91–1.02) | 0.95 (0.89–1.01) |
Abbreviations: CI=confidence interval; HBV=hepatitis B virus; HIV=human immunodeficiency virus; HR=hazard ratio; RNA=ribonucleic acid
For time-updated variables, a given patient may be included within more than one category.
Hazard ratios adjusted for all other risk factors listed in this table.
Diabetes mellitus was defined by: 1) hemoglobin A1c ≥6.5%, 2) prescription of anti-diabetic medication, or 3) record of a diabetes diagnosis plus the prescription of diabetes-related medication prior to start of follow-up.
History of heavy alcohol use defined as ever having reported while under observation in the NA-ACCORD: 1) inpatient or outpatient diagnosis of alcohol dependence/abuse, or 2) ≥3 drinks/day or ≥7 drinks/week for females; ≥4 drinks/day or ≥14 drinks/week for males on the self-reported Alcohol Use Disorders Identification Test-Consumption questionnaire.
Chronic hepatitis C virus infection was defined by detectable HCV RNA or available HCV genotype recorded at any time during observation.