Hepatocellular Carcinoma in HIV-Infected Populations

Hepatocellular carcinoma (HCC) has emerged as a significant non-AIDS defining malignancy among people living with HIV (PLWH). Co-infection with hepatitis B or C viruses amplifies underlying liver injury, accelerating fibrogenesis and carcinogenesis in an immunocompromised setting. Antiretroviral therapy has extended life expectancy but has also unmasked long-term complications such as HCC, which often presents at an advanced stage due to suboptimal surveillance and overlapping clinical features with cirrhosis. Chronic immune activation, immune exhaustion and altered tumour microenvironments have been identified as key biological drivers, with upregulation of inhibitory checkpoints and dysregulated T-cell phenotypes contributing to poorer outcomes. Socioeconomic disparities, access to viral hepatitis treatment and regional variations in aetiology further complicate early detection. Current strategies focus on risk stratification, integration of hepatology and HIV care, improved surveillance protocols and exploration of immunotherapeutic approaches tailored to PLWH.

Research from Nature Portfolio

Outcome data on locoregional therapy in HIV-associated HCC reveal that transcatheter arterial chemoembolisation (TACE) yields comparable survival in HIV-positive and HIV-negative patients when matched for tumour stage and liver function. One- and two-year overall survival rates after TACE in PLWH closely mirrored those of uninfected counterparts, indicating that HIV status per se need not preclude standard curative or palliative interventions. Prognostic determinants included serum alpha-fetoprotein levels, Child–Pugh score and maximum tumour diameter, while CD4 count below key thresholds increased infection risk without affecting long-term survival if appropriately managed. These findings support equal access to TACE for BCLC-B stage HCC irrespective of HIV infection, provided immune status is optimised prior to intervention.

Hepatocellular Carcinoma in HIV-Infected Populations publication trend

The graph below shows the total number of articles in hepatocellular carcinoma in hiv-infected populations across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatocellular carcinoma (HCC): The most common primary liver cancer arising from hepatocytes, often in the context of chronic liver disease.

CD4+ cell count: A measure of helper T lymphocytes, used to assess immune competence in HIV-infected individuals.

Programmed death-ligand 1 (PD-L1): An immune checkpoint protein expressed on tumour and immune cells that inhibits T-cell function when engaged.

Transcatheter arterial chemoembolisation (TACE): A minimally invasive procedure that delivers chemotherapy directly into the liver tumour’s blood supply while obstructing arterial flow to induce ischaemic necrosis.

Barcelona Clinic Liver Cancer (BCLC) staging: A widely used system that categorises HCC by tumour burden, liver function and performance status to guide treatment strategy.

References

1. Integrated phenotyping of the anti-cancer immune response in HIV-associated hepatocellular carcinoma. JHEP Reports (2023).
2. Risk of hepatocellular carcinoma in people with HIV in the United States, 2001-2019. Journal of the National Cancer Institute (2023).
3. Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV. Infectious Disease Reports (2022).
4. Outcome of TACE treatment in HIV infected patients with hepatocellular carcinoma. Scientific Reports (2021).