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Risk of Hepatocellular Carcinoma or Hepatic Decompensation Associated with Steatotic Liver Disease in People with and without HIV
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Open Forum Infectious Diseases, 07 October 20266
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July 17, 2026
DISCUSSION
Of the 19,546 patients without viral hepatitis or diagnosed cirrhosis included in our analyses, we found that radiographic report of SLD was highly prevalent in this sample of people who underwent liver imaging. Patients with SLD were more likely to be Hispanic, have a higher prevalence of cardiometabolic risk factors, higher risk alcohol use, but were not more likely to have HIV. When stratified by HIV and SLD status, PWH and SLD had the highest incidence rate of HCC/HD compared to PWoH and no SLD. People with SLD had >2-fold greater risk of HCC/HD, with PWH and SLD having the greatest risk of these severe liver events, after adjusting for demographics, cardiometabolic risk factors, alcohol, and tobacco use......suggesting accelerated hepatic fibrosis may occur in PWH and SLD.
After 15 years of follow-up, cumulative incidence of HCC/HD was highest among PWH and SLD at 7%. however, the cumulative incidence of HCC/HD among people with SLD did not differ significantly by HIV status.
Other factors independently associated with greater risk of HCC/HD included increasing age, diabetes, hypertension, alcohol abstinence with alcohol use disorder diagnosis or high-risk alcohol use when compared with lower-risk alcohol use (Table 2). Factors independently associated with lower risk of HCC/HD included non-Hispanic Black race, Hispanic ethnicity,
and BMI of 30-34.9 kg/m2.
Conclusion
Among people without cirrhosis or chronic viral hepatitis, radiographic findings of SLD were associated with increased rates of HCC/HD, with the highest rate among PWH and SLD, independent of cardiometabolic factors, alcohol, and tobacco.
CONCLUSIONS
Among people without cirrhosis or chronic viral hepatitis, radiographic findings of SLD are frequently observed and associated with increased risk of HCC/HD, independent of traditional risk factors including cardiometabolic factors and alcohol use. People with HIV and SLD were observed to have the highest rates of HCC/HD and greatest magnitude of risk for these severe liver events, though no statistical interaction between HIV and SLD was observed. Given the few HCC events observed, the risk of this event could not be evaluated separately.
future analysis should identify factors that may exacerbate or mitigate the progression of SLD to HCC in both PWH and PWoH, since such findings could inform personalized clinical risk stratification
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