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Hepatocellular Carcinoma and Non-Hodgkin's Lymphoma: The Roles of HIV, Hepatitis C Infection, and Alcohol Abuse

Kathleen A. McGinnis, Shawn L. Fultz, Melissa Skanderson, Joseph Conigliaro, Kendall Bryant, Amy C. Justice

From the Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System; the University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA; VA Connecticut Healthcare System, West Haven; Yale University School of Medicine, New Haven, CT; University of Kentucky, Lexington, KY; and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD

Address reprint requests to Amy C. Justice, MD, PhD, Department of Medicine, School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516; e-mail: amy.justice2{at}va.gov

Purpose: To explore the relationship of HIV, hepatitis C (HCV), and alcohol abuse/dependence to risk for hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL).

Patients and Methods: Male veterans (n = 14,018) with a first HIV diagnosis in the Veterans Affairs Healthcare System from October 1997 to September 2004; and 28,036 age-, race-, sex-, and location-matched HIV-negative veterans were identified. We examined the incidence of hepatocellular carcinoma and NHL and presence of HCV and alcohol abuse/dependence using International Classification of Diseases, ninth revision (ICD-9-CM) codes. HIV-positive to HIV-negative incident rate ratios (IRRs) and 95% CIs for the occurrence of hepatocellular carcinoma and NHL were calculated using Poisson regression models.

Results: HIV-positive veterans were at greater risk for hepatocellular carcinoma than HIV-negative veterans (IRR = 1.68; 95% CI, 1.02 to 2.77). After adjusting for HCV infection and alcohol abuse/dependence, HIV status was not independently associated with hepatocellular cancer (IRR = 0.96; 95% CI, 0.56 to 1.63). HIV-positive veterans had 9.71 times (95% CI, 6.99 to 13.49) greater risk of NHL than HIV-negative veterans. After adjusting for HCV and alcohol abuse/dependence, the IRR for NHL comparing HIV-positive with HIV-negative veterans is similar (IRR = 10.03, 95% CI, 7.19 to 13.97).

Conclusion: HIV-positive veterans have a higher relative incidence of hepatocellular carcinoma and NHL than HIV-negative veterans. For hepatocellular carcinoma, this association appears to be largely explained by the higher prevalence of HCV and alcohol abuse/dependence. Efforts to decrease hepatocellular carcinoma among persons with HIV should focus primarily on detecting and treating HCV and reducing heavy alcohol use.

Supported by an interagency agreement between the National Institute on Aging, the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism (Grant No. U01-13566) and the Veterans Affairs Health Services Research and Development Service (Grant No. RCD 04-125-1).

Presented as a poster at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.