With the development of genetics and molecular biology, the research on acute intermittent porphyria (AIP) has been gradually deepened, and its complication hepatocellular carcinoma (HCC) has attracted more and more attention. This article mainly summarizes the research advances in the pathogenesis and prevention of HCC in AIP. The pathogenesis of AIP with HCC is associated with oxidative stress, p53 mutation, downregulation of Bcl-2, increase in inflammatory cytokines, and iron overload, and its prevention strategies include the use of statins, strict management, liver transplantation, gene therapy, and enzyme replacement therapy. This article reviews the latest advances in the pathogenesis and prevention of AIP with HCC.