title: Hepatitis C coinfection increases the risk of fulminant hepatic failure in patients with HIV in the HAART era.
abstract: OBJECTIVE
  It is uncertain if patients coinfected with hepatitis C and HIV are more likely to suffer fulminant hepatic failure (FHF) when compared to patients with HIV-only.
  
  
  METHODS
  We conducted a retrospective cohort study using national administrative databases from the Department of Veterans Affairs in patients hospitalized for the first time with HIV and/or hepatitis C between 10/1991 and 9/2000. Fulminant hepatic failure was defined as occurring after the index hospitalization through 9/2001 in the absence of pre-existing liver disease. We calculated incidence rates, Kaplan Meier cumulative incidence curves, and Cox proportional hazards ratios while adjusting for demographics and other potential confounders.
  
  
  RESULTS
  We identified 11,678 patients with HIV-only and 4761 patients with coinfection. There were 92 cases of fulminant hepatic failure yielding an incidence rate of 1.1/1000 person-years and 2.5/1000 person-years in the HIV-only and coinfected groups. The cumulative incidence of fulminant hepatic failure in the coinfected group was higher than in the HIV-only group (P<0.0001). The risk of fulminant hepatic failure in patients with coinfection compared to HIV-only during the HAART era was several folds higher than that during the pre-HAART era.
  
  
  CONCLUSIONS
  HAART and hepatitis C coinfection appeared to act synergistically in HIV-infected patients to increase the risk of fulminant hepatic failure, a rare but often fatal disease.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center (152), Houston, TX 77030, USA. jkramer@bcm.tmc.edu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Julianne
authors.initials: J
authors.lastname: Souchek
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D008297:Male; D015999:Multivariate Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors