Journal of acquired immune deficiency syndromes (1999)
via Europe PMC
Evaluating Associations Between Cumulative Use of Chronic Liver Injury-Inducing Antiretroviral Therapy and Hepatocellular Carcinoma, by Chronic Liver Disease Status.
Torgersen J, Newcomb CW, Carbonari DM, +5 more, Lo Re V.
AI summary — for doctors, generated from the abstract only
Four or more years of ART with liver-injury mechanisms was linked to hepatocellular carcinoma in people with HIV without chronic liver disease, but not in those with it.
What was studied
Veterans Affairs cohort of 11,854 ART-naive people with HIV without CLD and 6,771 with CLD starting ART in 1999-2023, using marginal structural models to compare cumulative exposure to liver-injury-inducing ART with other ART.
Key findings
- 112 HCC events occurred without CLD and 378 with CLD.
- Without CLD, 4 or more years of exposure had OR 4.02 (95% CI 1.00-16.24).
- With CLD, the association was not significant (OR 1.36; 95% CI 0.68-2.72).
Clinical relevance
Long-term exposure to older hepatotoxic antiretrovirals may modestly raise HCC risk even in patients without known liver disease.
Who should care
Limitations
The confidence interval in the no-CLD group is very wide, borderline against 1.0, and observational data with misclassified exposure by fills may be confounded.
Favor regimens without chronic liver-injury mechanisms where feasible and keep HCC and liver surveillance in mind with prolonged exposure.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Prolonged exposure to hepatotoxic antiretroviral therapy (ART) could lead to chronic liver injury, which might increase risk of hepatocellular carcinoma (HCC). We used causal inference methods to evaluate if cumulative exposure to ART with known mechanisms of chronic liver injury is associated with HCC among people with HIV (PWH), by chronic liver disease (CLD) status.
Methods
We conducted a cohort study of antiretroviral-naive PWH with and without diagnosed CLD who initiated ART in the Veterans Affairs between 1999 and 2023. Exposure to ART with known mechanism of chronic liver injury (mitochondrial toxicity or accumulation of toxic intermediates) was determined monthly through prescription fills. Incident HCC was identified by Veterans Affairs National Cancer Registry and/or recorded diagnoses. Marginal structural models estimated odds ratios (ORs) with 95% confidence intervals (CIs) of HCC associated with cumulative exposure to chronic liver injury-inducing ART compared with ART without chronic liver injury mechanisms, by CLD status.
Results
Among 11,854 PWH without CLD and 6771 PWH with CLD, we observed 112 and 378 HCC events, respectively. Among PWH without CLD, ≥4 years of exposure to chronic liver injury-inducing ART was associated with HCC when compared with ≥4 years of use of ART without chronic liver injury mechanisms (OR = 4.02 [95% CI: 1.00-16.24]). Among PWH with CLD, ≥4 years of exposure to chronic liver injury-inducing ART was not associated with HCC (OR = 1.36; 95% CI: 0.68-2.72).
Conclusion
Four or more years of ART with a chronic liver injury mechanism was associated with HCC among PWH without CLD, but not those with CLD.
DOI
10.1097/qai.0000000000003923
PMID
42358057
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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