This study explores the epidemiology, treatment and outcomes of hepatocellular carcinoma (HCC) in a sub-Saharan cohort, comparing patients with and without human immunodeficiency virus (HIV). A retrospective cohort study of patients treated for HCC from 1 February 2011 to 29 February 2024 at Groote Schuur Hospital, South Africa was performed. Of the 501 HCC patients, 75 (15.0 %) were people living with HIV (PLWH). The PLWH were younger (43.7 ± 9.7 vs. 52.9 ± 15.3 years, p < 0.00001), had more frequent chronic hepatitis B virus (HBV) co-infection (85.3 % vs. 51.6 %, p < 0.00001) and no hepatitis C virus co-infection (0 % vs. 6.8 %, p = 0.013). More PLWH presented with Barcelona Clinic Liver Cancer Stage D disease (43.6 % vs. 27.7 %, p = 0.007). Similar proportions of PLWH and HIV-negative patients received curative-intended treatments, life-prolonging therapies and best supportive care. In PLWH, the median survival was lower (44 [IQR: 16-163.7] vs. 78 [IQR: 26-191] days, p = 0.010), and patients with HIV-HBV co-infection had the lowest survival (39 [IQR: 14.7-155.2] days). In a sub-Saharan HCC cohort, patients with HIV were significantly younger, had more advanced disease and HBV co-infection resulted in the lowest survival. Earlier detection through aggressive HCC screening is key to improving outcomes in PLWH.

Background: The impact of healthcare disparities on the outcomes for hepatocellular carcinoma (HCC) has not been explored in South Africa. This study aims to evaluate and compare the presentation, treatment, and outcomes of HCC in a cohort of patients treated in the public and private sectors. Methods: The records of 551 consecutive patients treated at a public hospital compared to those of 51 treated in the private sector from 1 December 2001 to 29 February 2024 were retrospectively reviewed. Results: Patients managed in the public sector were significantly younger (mean age: 49.6 ± 14.8 vs. 59.6 ± 14.3 years, p < 0.00001) and more likely to have hepatitis B virus (HBV)‐related HCC (62.1% vs. 17.6%, p < 0.00001). The prevalence of multifocal disease (59.2% vs. 15.7%, p < 0.00001), portal vein tumor thrombosis (44.6% vs. 5.9%, p < 0.00001), and pulmonary metastases (16.2% vs. 3.9%, p = 0.0143) was significantly higher in public sector patients. A significantly higher number of public sector patients received best supportive care as their only treatment (69.7% vs. 15.7%, p < 0.00001). A higher proportion of private sector patients were treated with curative‐intended therapies (ablation, liver resection, and liver transplantation) and transarterial modalities. Median survival was lower in public sector patients (68 [IQR: 25–232] vs. 703 [IQR: 388–1327] days, p < 0.001). There was no difference in survival between public and private sector patients treated with curative‐intended therapies. Conclusions: In the public sector, patients present with more advanced HCC, which limits their access to curative‐intended therapies, resulting in lower survival. Patients treated with curative‐intended therapies have similar survival rates in the public and private sectors. With the introduction of universal health coverage through the National Health Insurance program in South Africa, these data highlight the gaps in HCC care in the public sector, where health initiatives such as HBV vaccination, early treatment of HBV, patient education, and screening of at‐risk patients should be prioritized.

BackgroundJaundice is a marker of advanced disease and poor outcomes in hepatocellular carcinoma (HCC). The aim of this study was to describe and analyse the management and outcomes of jaundiced HCC patients at a large academic referral centre in sub-...

Introduction: Hepatocellular carcinoma (HCC) is a global health challenge, with disproportionately high mortalityrates in low- and middle-income countries (LMICs). Tumor markers such as alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) are used for diagnostic purposes and for monitoring treatment results. The relationship between these markers, individually or in combination, with clinicalpresentation, metastatic patterns and survival outcomes has not been extensively researched.Methods: In this South African retrospective study, we assess the association of the tumor marker levels on presentation, diagnosis, and prognosis. Data was analyzed using chi-square tests, t-tests, and Kaplan-Meier survivalanalysis.Results: The study included 501 patients, treated between 2010 and 2024. Elevated AFP levels were associatedwith chronic hepatitis B virus (HBV) infection, hepatomegaly, and pulmonary metastases, while elevated CA19-9levels were associated with more advanced liver disease. Survival analysis confirmed shorter survival for patientswith elevated AFP and CA19-9 levels compared to normal levels (p < 0.001). Elevated CEA levels were not significantlyassociated with survival. Patients with no elevated markers (i.e., “triple-negative” for AFP, CEA, and CA19-9) had the longest survival, compared to those with multiple elevated markers (p < 0.001).Conclusion: AFP and CA19-9 elevations were associated with more advanced disease and poorer survival outcomes.We emphasize the importance of integrating tumor marker levels with imaging and histopathology for amultimodal diagnostic approach. Further research is needed to validate these associations to better define therole of biomarkers in HCC management.