HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis.
The impact of human immunodeficiency virus (HIV) coinfection on the survival of patients with hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is unknown. Because HIV infection is no longer considered an absolute contraindication for liver transplantation in some countries, it has become a priority to address this topic. The objective of this study was to compare the survival of HIV-infected and HIV-uninfected patients with decompensated cirrhosis due to HCV. In a retrospective cohort study, the survival of 1,037 HCV monoinfected and 180 HCV/HIV-coinfected patients with cirrhosis after the first hepatic decompensation was analyzed. Of the group, 386 (37%) HCV-monoinfected and 100 (56%) HCV/HIV-coinfected subjects died during the follow-up. The median survival time of HIV-infected and HIV-uninfected patients was 16 and 48 months, respectively (P < .001). The relative risk (95% CI) of death for HIV-infected patients was 2.26 (1.51-3.38). Other independent predictors of survival were age older than 63 years (2.25 [1.53-3.31]); Child-Turcotte-Pugh class B versus class A (1.95 [1.41-2.68]) and class C versus class A (2.78 [1.66-4.70]); hepatitis D virus infection (1.56 [1.12-4.77]); model for end-stage liver disease score, (1.05 [1.01-1-11]); more than one simultaneous decompensation (1.23 [1.12-3.33]); and the type of the first hepatic decompensation, with a poorer prognosis associated with encephalopathy compared with portal hypertensive gastrointestinal bleeding (2.03 [1.26-3.10]). In conclusion, HIV coinfection reduces considerably the survival of patients with HCV-related ESLD independently of other markers of poor prognosis. This fact must be taken into account to establish the adequate timing of liver transplantation in HIV-coinfected subjects.
Pineda
Juan A
JA
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Valme, 41014 Sevilla, Spain. japineda@nacom.es
Romero-Gómez
Manuel
M
Díaz-García
Fernando
F
Girón-González
José A
JA
Montero
José L
JL
Torre-Cisneros
Julián
J
Andrade
Raúl J
RJ
González-Serrano
Mercedes
M
Aguilar
José
J
Aguilar-Guisado
Manuela
M
Navarro
José M
JM
Salmerón
Javier
J
Caballero-Granado
Francisco J
FJ
García-García
José A
JA
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006526:Hepatitis C / Q000150:complications*; D003699:Hepatitis D / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis