The landscape of HIV has changed from an incurable disease to be more like a chronic disease as the result of advances in medications; the lifespan of People Living with HIV (PLHIV) has also lengthened, HIV defining diseases are delayed, and many of the complications of HIV prevented with adherence to medications. The stigma and discrimination of HIV remain however. PLHIV need to cope with emotional issues of guilt, shame, and self-blame; social issues of rejection, termination of employment, fear and bad social experiences. The paradigm shift from negative regard of PLHIV to that of empathy, which is a deliberate and conscious attitude to relate to PLHIV as fellow travellers in life, to be able to feel with them rather than against them, has therapeutic effects. Empathy has its processes of active listening, responding with appropriately chosen words to describe feelings of the patients, and reflecting the desire to understand more about the patient’s emotions and social turmoil. The benefit of empathy in counseling are the ability to connect with the patient, to build trust from the patient being counseled, and a more objective perspective of being able to see the patient from his/her perspective rather than from the therapist’s perspective. More importantly empathy is a positive response to emotional and social issues experienced by the patient compared to platitudes like “You will be alright; or “don’t worry”, which negate and minimise the opportunity to have a catharsis.

Background/Aims: Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods: We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results: Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients. Conclusions Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.