Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease.
OBJECTIVE
To find the survival and the predictors of death of HIV-infected patients with hepatitis C virus (HCV)-related end-stage liver disease (ESLD).


METHODS
A prospective cohort study set in the infectious diseases units of four tertiary care public hospitals in Andalucía, Spain. From a multicentric cohort of 2664 HIV/HCV-co-infected patients, all consecutive patients with HCV-related cirrhosis who presented with the first hepatic decompensation from January 1997 to June 2004 were followed-up and 153 patients were included. The survival and the demographic, HIV-related and liver-related factors associated with death were evaluated.


RESULTS
Ninety-five (62%) patients died during the follow-up. In 79 (85%) individuals, the cause of death was liver related. The median survival time was 13 months. Independent predictors of survival were Child score [hazard ratio (HR), 1.2; 95% confidence interval (CI), 1.08-1.37; P = 0.001], CD4+ cell count at decompensation lower than 100 cells/microl (HR, 2.48; 95% CI, 1.52-4.06; P < 0.001) and hepatic encephalopathy as the first hepatic decompensation (HR, 2.45; 95% CI, 1.41-4.27; P = 0.001). HAART was prescribed to 101 (66%) patients. The cumulative probability of survival in patients under HAART was 60% at 1 year and 40% at 3 years, versus 38 and 18%, respectively, in patients not treated with HAART (P < 0.0001). The HR (95% CI) of death in patients on HAART was 0.5 (0.3-0.9), (P = 0.03). CONCLUSIONS The survival of HIV/HCV-co-infected patients with ESLD is extremely poor. Immunosuppression and markers of severe liver disease predict liver-related mortality in these patients. HAART seems to be associated with a reduced liver-related mortality.
Merchante
Nicolás
N
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Valme, Sevilla, Spain.
Girón-González
José A
JA
González-Serrano
Mercedes
M
Torre-Cisneros
Julian
J
García-García
José A
JA
Arizcorreta
Ana
A
Ruiz-Morales
Josefa
J
Cano-Lliteras
Pilar
P
Lozano
Fernando
F
Martínez-Sierra
Carmen
C
Macías
Juan
J
Pineda
Juan A
JA
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006526:Hepatitis C / Q000150:complications / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D019562:Viral Load
D017320:HIV Protease Inhibitors