Natural history of compensated viral cirrhosis in a cohort of patients with HIV infection.
BACKGROUND
The natural history of initially compensated cirrhosis in patients with HIV and concurrent hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is poorly defined. This study was designed to investigate the incidence and type of liver-related complications and mortality in coinfected cirrhotic patients.


METHODS
We retrospectively identified a cohort of patients coinfected with HIV and HCV or HBV and initially compensated viral cirrhosis. Time to decompensation and mortality from liver-related causes were recorded.


RESULTS
Between 1999 and 2004, 392 HIV-infected patients underwent a follow-up of > or =6 months. Sixty-nine patients (17.6%) with initially compensated cirrhosis were identified (7 HBV positive, 59 HCV positive, and 3 positive for both HBV and HCV). The most frequent complication was ascites. The mortality was 71.3 per 1000 person-years (95% confidence interval [CI], 47 to 108) in HIV-infected patients with HBV and/or HCV compensated cirrhosis, 8 (95% CI, 4 to 16) in HIV/HCV-coinfected patients without cirrhosis, and 6.5 (95% CI, 2.7 to 15.5) in HIV-monoinfected patients. After the first event of decompensation, the survival rate was 48% at 1 year and 18.1% at 3 years. Treatment with HAART after the first event of decompensation was associated with an increased survival rate (61.1% and 26.2% at 1 and 3 years, respectively, vs. 26.7% and 0%; P < 0.0001).


CONCLUSIONS
These results indicate significant morbidity and mortality during the 6 years after the diagnosis of compensated cirrhosis due to HBV and/or HCV in HIV-infected patients, identifying ascites as the most frequent complication.
Bruno
Raffaele
R
Division of Infectious and Tropical Diseases, Instituto di Ricerca e Cura a Carattere Scientifico, San Matteo Hospital, University of Pavia, Italy. r.bruno@smatteo.pv.it
Sacchi
Paolo
P
Puoti
Massimo
M
Maiocchi
Laura
L
Patruno
Savino
S
Carosi
Giampiero
G
Filice
Gaetano
G
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors