title: The natural history of liver cirrhosis in HIV-hepatitis C virus-coinfected patients.
abstract: OBJECTIVE
  To provide detailed information about the natural history of HIV-hepatitis C virus (HCV)-coinfected patients with cirrhosis.
  
  
  METHODS
  Prospective cohort including 340 HIV-HCV-coinfected patients with compensated (n = 248) or decompensated (n = 92) cirrhosis. We evaluated predictors of survival and of first hepatic decompensation.
  
  
  RESULTS
  The mortality rate for patients with decompensated and compensated cirrhosis was 27.14 deaths per 100 person-years [95% confidence interval (CI) 18.93-35.35] and 3.98 deaths per 100 person-years (95% CI 2.42-5.54), respectively. Rate of first hepatic decompensation in patients with compensated cirrhosis was 4.62 per 100 persons-years (95% CI 2.91-6.33). In the complete cohort, permanent HAART interruption during follow-up, CD4 cell count nadir and baseline Child-Pugh score (CPS) B or C were significantly associated with shorter survival. In patients with compensated cirrhosis factors significantly associated with decreased survival were having the first hepatic decompensation during follow-up, permanent HAART discontinuation, and CPS B and C at baseline. For patients with compensated cirrhosis, time since diagnosis of HCV infection, CPS B and C and permanent HAART discontinuation were significantly associated with the risk of first hepatic decompensation. Sustained viral response to anti-HCV therapy was not independently associated with better survival in patients with compensated cirrhosis.
  
  
  CONCLUSIONS
  HIV-HCV-coinfected patients with cirrhosis have a relatively good 3-year survival (87%). In contrast, 2-year survival of patients with decompensated liver cirrhosis is only 50%. Three-year survival was mostly impacted by liver-related factors and HAART maintenance.
authors.affiliation: Infectious Diseases Service Hospital Clinic i Provincial, Central University School of Medicine, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: López-Diéguez
authors.forename: María L
authors.initials: ML
authors.lastname: Montes
authors.forename: José F
authors.initials: JF
authors.lastname: Pascual-Pareja
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Von Wichmann
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.forename: Asunción
authors.initials: A
authors.lastname: Hernando
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
authors.forename: Lucia
authors.initials: L
authors.lastname: Serrano
authors.forename: José R
authors.initials: JR
authors.lastname: Arribas
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology; D016174:Hepacivirus / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies