TOPLINE: 

Among patients with HIV-hepatitis C virus (HCV) coinfection and advanced liver fibrosis or cirrhosis treated with direct-acting antivirals (DAAs), 2.54% would have been diagnosed with hepatocellular carcinoma (HCC) by 6 years post-treatment; however, the annual probability decreased during follow‑up.

METHODOLOGY: 

• Researchers analyzed data from an international collaboration of cohorts in Europe and North America to estimate the risk for HCC after DAA therapy in people with HIV-HCV co-infection and advanced liver fibrosis or cirrhosis.
• A total of 3824 patients who were DAA‑naive and were virologically suppressed on antiretroviral therapy were included, of whom 2373 initiated DAA (median age, 57 years; 86.1% men).
• The main outcome was a new diagnosis of HCC; in addition, 6-year risk and annual probability of HCC were estimated.
• The median follow-up duration was 4.3 years after initiation of DAA therapy.

TAKEAWAY: 

• Among patients who initiated DAA therapy, 43 were diagnosed with HCC and 301 died; the estimated 6-year risk was 2.54% (95% CI, 1.59-3.90).
• The estimated annual probability of being diagnosed with HCC declined over time, to 0.81% (95% CI, 0.34-1.54) from baseline to month 12 after DAA initiation and 0.10% (95% CI, 0.01-0.24) at year 5-6.
• For patients with cirrhosis, the estimated annual probability of being diagnosed with HCC was 0.78% from baseline to month 12 after DAA initiation; this decreased to 0.07% in year 5-6. Among those with advanced fibrosis, the 6-year risk for HCC was 1.59%, with a crude incidence of 0.30 case per 100 person-years.

IN PRACTICE:

“Our findings suggest that HCC surveillance appears to be most crucial during the initial years post-DAA in people with HIV,” the authors wrote.

SOURCE:

The study was led by Daniela K. van Santen, Harvard T.H. Chan School of Public Health, Harvard University, Boston. It was published online on November 19, 2025, in Clinical Infectious Diseases.

LIMITATIONS:

The estimates assumed that rates of DAA adherence and sustained virologic response would be similar in the treated and untreated groups if all eligible individuals had received DAA. Because DAA is often withheld from patients with a short life expectancy, the available data may not have fully captured immediate mortality risk. Furthermore, cases of HCC detected shortly after baseline may have reflected previously undiagnosed prevalent disease rather than new events.

DISCLOSURES:

This study was funded by the National Institutes of Health. Several authors disclosed receiving consulting honoraria and/or research grants, travel grants, and financial compensation for participation on advisory boards or as speakers from multiple pharmaceutical companies and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.