title: Reduction in liver-related hospital admissions and deaths in HIV-infected patients since the year 2002.
abstract: Since the advent of highly active antiretroviral therapy (HAART), complications of chronic liver disease (CLD) have emerged as one of the leading causes of hospital admission and death among HIV-infected patients with chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infections. The impact of CLD on hospital admissions and deaths in HIV-infected patients attended at one reference HIV hospital in Madrid during the last 9 years was analysed. All clinical charts from January 1996 to December 2004 were retrospectively examined. Demographics, discharge diagnosis, complications during inhospital stay and causes of death were recorded. A total of 2527 hospital admissions in 2008 distinct HIV-infected persons were recorded. Overall, 84% were iv drug users; mean age was 37 years and the mean CD4 count was 224 cells/muL. Both mean age and CD4 count significantly increased during the study period (P < 0.01). Overall, 42% of hospitalized patients were on antiretroviral therapy. Decompensated CLD was the cause of admission and/or developed during hospitalization in 345 patients (14%). Admissions caused by decompensated CLD increased significantly from 9.1% (30/329) in 1996 to 26% (78/294) in 2002. A significant steady decline occurred since then, being 11% (29/253) in the year 2004. Similarly, inhospital liver-related deaths were 9% (5/54) in 1996, peaked to 59% (10/17) in 2001 and declined to 20% (3/15) in the year 2004. Chronic hepatitis C was responsible for admissions and/or deaths in 73.5% of CLD cases. In conclusion, the rate of liver-related hospital admissions and deaths among HIV-infected patients peaked in the year 2002 and has steadily declined since then. A slower progression to liver cirrhosis in patients on HAART, avoidance of hepatotoxic antiretroviral drugs and more frequent use of anti-HCV therapy in HIV/HCV-coinfected patients could account for this benefit.
authors.affiliation: Service of Infectious Diseases and Hepatology Unit, Hospital Carlos III, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Martín-Carbonero
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Somolinos
authors.forename: J
authors.initials: J
authors.lastname: García-Samaniego
authors.forename: M J
authors.initials: MJ
authors.lastname: Núñez
authors.forename: M E
authors.initials: ME
authors.lastname: Valencia
authors.forename: J
authors.initials: J
authors.lastname: González-Lahoz
authors.forename: V
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D016174:Hepacivirus; D006526:Hepatitis C / Q000401:mortality; D006801:Humans; D008107:Liver Diseases / Q000401:mortality* / Q000821:virology*; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology