Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol.
OBJECTIVE
We analyzed the characteristics of HIV infected patients who died from liver disease, focusing on hepatitis virus co-infection.


METHODS
One-hundred and eighty-five French hospital departments involved in HIV/AIDS management prospectively notified all deaths occurring in 2000. Patients whose hepatitis C (HCV) and hepatitis B (HBV) serostatus was known were classified as being infected by HCV alone, HBV alone (HBsAg positive), both HCV and HBV, or neither HCB nor HBV.


RESULTS
Among 822 HIV infected patients, 29% were infected by HCV alone, 8% by HBV alone, and 4% by both HCV and HBV. The most frequent causes of death were liver disease (31% of cases) and AIDS (29%) among HIV-HCV co-infected patients, and AIDS (38%) and liver disease (22%) among HIV-HBV co-infected patients. Liver disease was a more frequent cause of death among patients co-infected by both HCV and HBV (44% of cases). Hepatocellular carcinoma was present in 15% of patients who died from liver disease, and was associated with HBV co-infection. Nearly half the patients who died from liver disease had more than 200 CD4/mm3.


CONCLUSIONS
Liver disease is now a leading cause of death among HIV-HCV co-infected patients and is becoming an important cause of death among HIV-HBV co-infected patients. The risk of death from liver disease is highest in patients co-infected by both HCV and HBV.
Internal Medicine Department, Cochin Hospital, Paris, France. dominique.salmon@cch.ap-hop-paris.fr
Dominique
D
Salmon-Ceron
Charlotte
C
Lewden
Philippe
P
Morlat
Sibylle
S
Bévilacqua
Eric
E
Jougla
Fabrice
F
Bonnet
Laurence
L
Héripret
Dominique
D
Costagliola
Thierry
T
May
Geneviève
G
Chêne
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002423:Cause of Death; D015897:Comorbidity; D003625:Data Collection; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006509:Hepatitis B / Q000188:drug therapy / Q000401:mortality*; D006526:Hepatitis C / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000401:mortality*; D008297:Male; D012307:Risk Factors; D016036:Seroepidemiologic Studies
D000998:Antiviral Agents