Highlights • This case report describes the first reported use of lenvatinib in two participants with unresectable HCC recurrence. • Although the presently reported two cases had a good liver functional reserve and an intermediate BCLC score, they discontinued lenvatinib because of low tolerability. • The presently reported cases underline the need to provide cumulative data on PLWH with unresectable HCC, addressing the choice between sorafenib and lenvatinib in this setting.