Clinical outcomes of HIV-HCV co-infection in a large cohort of hemophiliac patients.
OBJECTIVE
To determine the disease progression of HIV-HCV co-infected hemophiliacs in a large cohort of patients (n = 288) cared for at a single medical institution.


METHODS
Annual mortality rates for AIDS- and liver-related death were calculated and Kaplan-Meier survival plots were drawn to determine the progression to AIDS and death.


RESULTS
Between January 1985 and December 2002, 179 (62.2%) and 195 (67.7%) of these patients had developed AIDS or died, respectively. Overall, AIDS accounted for 128 deaths, which almost entirely (93.7%) occurred prior to the introduction of highly active antiretroviral therapy (HAART) at the end of 1995. A total of 29 patients died of liver failure, most of them (69%) during the years 1991-1996. Since 1997, only five cases of fatal liver failure were reported. Non-HIV-HCV related reasons were responsible for 38 deaths and occurred predominantly (47%) in the years 1997-2002. Starting November 1995, 72 patients were treated with HAART. However, by December 2002, only 52.5% and 83% of all HAART-treated patients had a stable viremia (<400 copies/ml) and a sufficient CD4(+) T-cell count (>200/microl), respectively.


CONCLUSIONS
These data indicate that liver-related mortality peaked in the years 1991-1996, but subsequently tended to decline. Moreover, despite widespread treatment of patients with HAART, a significant proportion of individuals had an unsatisfactory immunological and virological status at the end of 2002.
Lichterfeld
Mathias
M
Department of General Internal Medicine, Rheinische Friedrich-Wilhelms Universität, 53105 Bonn, Germany. mlichterfeld@partners.org
Schmeisser
Norbert
N
Qurishi
Nazifa
N
Vogel
Martin
M
Brackmann
Hans-Hermann
HH
Spengler
Ulrich
U
Rockstroh
Juergen K
JK
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D019380:Anti-HIV Agents