358. HIV Infection and the Risk of Hepatocellular Carcinoma in Patients with Hepatitis B Virus (HBV) Co-infection: a Propensity Score-matched Cohort Study

Abstract

BackgroundThere is a paucity of data to show whether HIV infection would affect the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection.MethodsA territory-wide cohort study was performed to determine the risk of HCC in patients with HBV with and without HIV co-infection. All patients with HBV/HIV co-infection and HBV mono-infection treated with antiviral therapy in public hospitals in Hong Kong from 2000 to 2017 were identified from an electronic database. Patients with hepatitis C virus (HCV) infection, HCC diagnosed within six months, or follow-up less than 6 months were excluded. The primary outcome was HCC. A propensity score (PS) for each patient was defined as the conditional probability of having HIV infection given the baseline characteristics (including age, sex, cirrhosis, bilirubin, alanine transaminase/ALT, platelet, albumin, and prothrombin time). HBV/HIV-co-infected and HBV-monoinfected patients were matched in a 1:5 ratio by PS matching. Weighted Fine-Gray subdistribution hazards model was estimated, where the variables included were HIV status and ALT as the other important co-variates were well matched.ResultsA total of 822 HBV/HIV-coinfected and 53,974 HBV-monoinfected patients were identified, and 692 and 38,102 were included for PS matching (Figure 1). Six hundred and three HBV/HIV-coinfected and 2,380 HBV-monoinfected patients were included in the final analysis. Among this cohort, 85% were male, mean (± standard deviation) age was 42 ± 12 years, and 4.5% had cirrhosis at baseline. At a median follow-up of 5.8 (interquartile range 2.6–9.6) years, 7 (1.2%) and 75 (3.2%) HBV/HIV-coinfected and HBV-monoinfected patients developed HCC, respectively. Weighted Fine-Gray model showed that HIV infection was associated with a lower risk of HCC (subdistribution hazard ratio 0.39, 95% confidence interval 0.16–0.94, P = 0.036) (Figure 2).ConclusionHIV/HBV co-infected patients had lower risk of HCC compared with antiviral therapy-treated HBV-monoinfected patients. This observation can be explained by a lower threshold, in terms of severity of liver disease, to start antiviral treatment in HBV/HIV-coinfected compared with HBV-monoinfected patients. Disclosures All authors: No reported disclosures.