NA-ACCORD is a collaborative study that pools individual-level data from 22 HIV clinical and interval cohorts in Canada and US. Design, data collection, and data harmonization methods have been previously described.21,22 Individuals were enrolled into NA-ACCORD from contributing cohorts when they had 2 or more clinical or study visits within 12 months. Each cohort reported demographic, medication, laboratory, diagnoses, and vital status data annually to the Data Management Core for data harmonization and quality control. Data were then sent to the Epidemiology/Biostatistics Core, where analytic-ready summary files were completed. Institutional review boards at each study location approved the study protocol, and each participant provided written informed consent. Consortium activities were approved by the Johns Hopkins University institutional review board. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We included PWH aged 18 years or older with available CD4 cell counts and HIV RNA data between 1996 and 2015; 11.6% of participants were excluded because of missing data (inclusion criteria are shown in eFigure 1 in the Supplement). Three cART eras were analyzed: early cART (1996-2000), middle cART (2001-2005), and modern cART (2006-2015), corresponding to temporal changes in cART regimens.22,23,24 Person-time at risk for HCC accrued from the later of the first date of the cART era, participants’ enrollment into NA-ACCORD, first available CD4 cell count and/or HIV RNA level measurement, or beginning of cohort-specific cancer diagnosis ascertainment. Participants no longer contributed person-time at the first date of HCC diagnosis, death, December 31, 2015, or end of cohort-specific cancer ascertainment.

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