Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study.
OBJECTIVE
Longer exposure to hepatitis C (HCV) or B virus (HBV) and the increased use of hepatitis treatment might have an impact on liver-related deaths in patients co-infected with the Human Immunodeficiency Virus (HIV). We describe the proportion of liver-related deaths among HIV-infected patients in 2005 compared with 2000.


METHODS
In a nationwide survey (341 hospital departments involved in HIV management), all deaths of HIV-infected patients were prospectively reported. Deaths from either cirrhosis, hepatocellular carcinoma or fulminant hepatitis were defined as liver-related deaths.


RESULTS
Of the 898 deaths reported in 2005, liver-related causes accounted for 15.4%; this is compared to 13.4% in 2000. Among liver-related deaths, hepatocellular carcinoma increased from 15% to 25% (p=0.04). Among hepatocellular carcinoma-related deaths: in 2000, 10% were HCV-infected; in 2005, 25% were HCV-infected (p=0.03). Half of the HCV-related deaths had been treated for HCV but 98% remained HCV-RNA positive at time of death. The proportion of HBV-related deaths remained stable between 2000 and 2005.


CONCLUSIONS
Liver-related deaths, mainly liver cancers, have increased in HIV-infected patients in France despite wide access to HCV treatment. The stability of HBV-related deaths might be explained by the use of dually active antiretroviral drugs in co-infected patients.
Salmon-Ceron
Dominique
D
Infectious Diseases, Internal Medicine Department, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. dominique.salmon@cch.aphp.fr
Rosenthal
Eric
E
Lewden
Charlotte
C
Bouteloup
Vincent
V
May
Thierry
T
Burty
Christine
C
Bonnet
Fabrice
F
Costagliola
Dominique
D
Jougla
Eric
E
Semaille
Caroline
C
Morlat
Philippe
P
Cacoub
Patrice
P
Chêne
Geneviève
G
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D020010:Heterosexuality; D006716:Homosexuality; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000453:epidemiology