No conflict of interest to declare The effect of HIV infection on the age at presentation of HBV-driven hepatocellular carcinoma in South Africa Tongai Maponga, Hannali Vermeulen, Barbra Robertson, Sean Burmeister, Wolfgang Preiser, Paul Ruff, Judith Jacobson, Michael Kew, Monique Andersson No conflict of interest to declare

Study aim To describe occurrence of HIV infection among patients with incidental HCC diagnosis from 4 oncology units in South Africa.

Results 107 HCC patients recruited over 3 years. 83/107 (78%) were male. 68/106 (64.1%) of the HCC cases were HBsAg positive. 22/100 (22%) were HIV-infected. HBsAg a marker of active infection 7 cases not tested for HIV due to insufficient sample, excluded from analysis.

Results HIV-infected n = 22 HIV-uninfected n = 78 p Table 1: Demographics of HIV-infected and HIV-uninfected HCC patients HIV-infected n = 22 HIV-uninfected n = 78 p Age, years [median (IQR)] 37 (35-45) 48 (33-57) 0.07 Male gender,[n (%)] 14 (64) 64 (82) 0.01 Race: Black Mixed ancestry Caucasian Not specified 20 2 32 36 6 4 ns HBsAg positive [n(%)] 18 (82) 47 (60) Anti-HCV positive [n(%)] 1/21 (5) 7/75 (9) Significantly higher proportion of women among the HIV infected HCC cases.

HBV/HIV co-infected (n=18) HBV mono-infected (n=47) Results Table 2: Virologic characteristics of co-infected and HBV-mono-infected HCC patients HBV/HIV co-infected (n=18) HBV mono-infected (n=47) p Age in years, [median (IQR)] 37 (34 - 46) 41 (33 - 54) 0.4 Male gender, n (%) 12 (67%) 41 (87%) 0.01 HBeAg positivity 10/17 (59%) 9/46 (20%) 0.005 Log10 HBV VL (IU/ml), [median (IQR)] 5.2 (3.3 - 6.7) 4.8 (3.5 - 6.9) ns HBV genotypes A D E   9 - 25 7 2 0.6 Anti-HCV positive 1/17 (6%) 3/45 (7%) 1.0 eAg, a marker of high HBV infectivity in untreated infection, associated with increased risk of cancer an

Results Trend toward a younger age at HCC presentation among HIV/HBV co-infected women compared to those with HBV mono-infection. 37 years (IQR: 35 - 39) vs. 50 years (IQR: 37 - 62), p=0.09. Difference not as apparent between co-infected and mono-infected males. 39 years (IQR: 33 - 48) vs. 41 years (IQR: 33 - 54), p=0.7

HBV/HIV co-infected (n=18) HBV mono-infected (n=47) Results Table 3: Clinical characteristics of co-infected vs HBV-mono-infected HCC patients HBV/HIV co-infected (n=18) HBV mono-infected (n=47) p Anti-HCV positive 1/17 (6%) 3/45 (7%) 1.0 AFP >400 ng/dL 11/18 (61%) 35/44 (80%) 0.2 Nodules at diagnosis, [n (%)] Multiple lesions Single lesion <2cm Single lesion >5cm   11 (69) 3 (19) 2 (12) 31 (74) 5 (12) 6 (14) 0.8

Conclusions The results suggest altering of HCC epidemiology, especially among co-infected women resulting in presentation at younger age. Modification of hepatocarcinogenesis in HIV? Prognosis of HCC remains poor despite available guidelines for screening and surveillance. Timely HBV diagnosis? Implementation of guidelines? Larger multi-centre studies are required to improve our understanding of HCC epidemiology in HIV infection. Global Strategy on Elimination of Viral Hepatitis must be implemented.

Acknowledgements CUSATPRAM-D43 programme