title: Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus.
abstract: BACKGROUND
  Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality.
  
  
  RESULTS
  We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality rates (EMR) for siblings of HIV/HCV-co-infected individuals (n = 436) and siblings of HIV mono-infected individuals (n = 1837) compared with siblings of population controls (n = 281,221). Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56-4.50) per 1,000 person-years, compared with siblings of matched population controls. Substance abuse-related deaths contributed most to the elevated mortality among siblings [EMR = 2.25 (1.09-3.40)] followed by unnatural deaths [EMR = 0.67 (-0.05-1.39)]. No siblings of HIV/HCV co-infected patients had a liver-related diagnosis as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16-1.05) compared with siblings of controls. This modest excess mortality was due to deaths from an unknown cause [EMR = 0.28 (0.07-0.48)], deaths from substance abuse [EMR = 0.19 (-0.04-0.43)], and unnatural deaths [EMR = 0.18 (-0.06-0.42)].
  
  
  CONCLUSIONS
  HCV co-infection among HIV-infected patients was a strong marker for family-related mortality due to substance abuse and other unnatural causes. To reduce morbidity and mortality in HIV/HCV-co-infected patients, the advances in antiviral treatment of HCV should be accompanied by continued focus on interventions targeted at substance abuse-related risk factors.
authors: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. ann-brit.eg.hansen@rh.regionh.dk
authors: Ann-Brit Eg
authors: AB
authors: Hansen
authors: Nicolai
authors: N
authors: Lohse
authors: Jan
authors: J
authors: Gerstoft
authors: Gitte
authors: G
authors: Kronborg
authors: Alex
authors: A
authors: Laursen
authors: Court
authors: C
authors: Pedersen
authors: Henrik Toft
authors: HT
authors: Sørensen
authors: Niels
authors: N
authors: Obel
mesh_terms: D002423:Cause of Death; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D035781:Siblings; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000401:mortality
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