Trends in mortality according to hepatitis C virus serostatus in the era of combination antiretroviral therapy.
OBJECTIVE
To study trends in overall deaths and cause-specific deaths stratified by hepatitis C virus (HCV) serostatus in a cohort of combination antiretroviral (cART)-naive HIV-infected patients in Spain.


METHODS
We analyzed data from 1997 to 2008 in two calendar periods: 1997-2003 and 2004-2008. Deaths were ascertained through cohort reporting and a cross-match with the Spanish National Death Index. We used Poisson regression to model mortality rates and risk factors.


RESULTS
We analyzed 5974 HIV-positive cART-naive patients: 2471 (1497 HCV positive) in the period 1997-2003, and 3503 (689 HCV positive) in the period 2004-2008. A total of 232 deaths (158 during the first period, and 74 during the second period) were detected during 19 416 person-years of follow-up; the death rate was 12.9 of 1000 person-years. Crude overall death rates [95% confidence interval (CI)] were 16.5 (14.2-19.1) in 1997-2003 and 8.5 (6.7-10.6) in 2004-2008. The incidence rate ratio (IRR) (95%CI) in 2004-2008 taking 1997-2003 as a reference was 0.51 (0.39-0.67). When we stratified by HCV serostatus, the overall death IRR (95% CI) taking 1997-2003 as reference was 0.52 (0.32-0.85) for HCV-negative patients and 1.27 (0.90-1.79) for HCV-positive patients. When we considered cause-specific deaths (liver-related, AIDS-related, and nonliver-related/non-AIDS-related), findings were similar to those for overall-deaths.


CONCLUSIONS
Taking the first years of the cART era as a reference, we observed a decrease in overall and cause-specific mortality. This decrease was only observed in HCV-negative patients.
Hospital General Universitario Gregorio Marañón, Spain. jbb4@me.com
Juan
J
Berenguer
Belén
B
Alejos
Victoria
V
Hernando
Pompeyo
P
Viciana
Miguel
M
Salavert
Ignacio
I
Santos
Juan L
JL
Gómez-Sirvent
Francesc
F
Vidal
Joaquín
J
Portilla
Julia
J
Del Amo
D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death / Q000639:trends; D060085:Coinfection; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D006526:Hepatitis C / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016012:Poisson Distribution; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult