Comparable 5-Year Survival in People With and Without HIV Following Hepatocellular Carcinoma Diagnosis: A Multicenter Study

Background and Aims: Conflicting data on hepatocellular carcinoma (HCC) survival in people with HIV (PWH) may depend on tumour aggressiveness and access to curative treatments. We compared outcomes of two HCC cohorts according to HIV status. Methods: Patients from four tertiary referral centers in Northern Italy with the first HCC diagnosis (2005–2023) were analysed. Clinical characteristics, treatment access, and overall survival (OS) were described by HIV status, using inverse probability treatment weighting and propensity score (IPTW/PS) methods. Cox regression models assessed mortality predictors and recurrence after initial treatment. Results: Among 606 patients, 143 were PWH and 463 HIV-negative. PWH were younger (median age 53 vs. 68 years, p < 0.001), predominantly male (87% vs. 75%, p = 0.004), with a lower proportion of Child-Pugh A cirrhosis (71% vs. 76%, p = 0.01). Despite similar surveillance rates (91% vs. 88%), PWH more frequently presented with BCLC-C stage HCC (22% vs. 10%, p < 0.001). First-line curative treatments were offered to 47% of PWH and 60% of HIV-negative patients (p = 0.006), while second-line treatment rates were similar (42% vs. 44%, p = 0.91). During median follow-up of 32 (11–78) and 36 (19–84) months for PWH and HIV-negative subjects (p = 0.04), five-year OS was 43.4% versus 44.1% (p = 0.97), median OS was 48 [interquartile range (IQR) 15–127] versus 46 (IQR 21–109) months (p = 0.97). Multivariable analysis after IPTW/PS showed similar mortality (HR 1.03, 95% CI 0.52–1.99, p = 0.94) but a higher two-year recurrence rate in PWH (47.4% vs. 22.8%, p = 0.03). Conclusion: Despite more advanced tumours and higher recurrence, survival in PWH with HCC was similar. Access to curative treatments with aggressive downstaging strategies may counterbalance initial disadvantages.