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8081IMPACT OF HIV COINFECTION ON THE AGE AND THE CAUSE OF DEATH IN PATIENTS WITH HCV CIRRHOSIS

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  • claudine intexas
    Dec 1, 2001
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      NATAP - www.natap.org
      --------------------------------------

      AASLD
      Nov 9-13, Dallas
      Reported by Jules Levin
      see NATAP website for more AASLD coverage

      Abstract 1095. IMPACT OF HIV COINFECTION ON THE AGE
      AND THE CAUSE OF DEATH IN PATIENTS WITH HCV CIRRHOSIS

      Vincent Di Martino, Lucas Cavallaro, Joel Ezenfis,
      Marie-H�l�ne Tainturier, Yves Benhamou, Marie Bochet,
      Christine Katlama, Thierry Poynard, Multivirc Group,
      GH Piti�-Salp�tri�re, Paris France

      Background/Aim: Long-term follow-up observation of
      patients with HCV-related cirrhosis is of considerable
      help for validating modeling of the natural history of
      hepatitis C and pharmaco-economic studies. HIV
      coinfection was shown to worsen the course of chronic
      hepatitis C but whether HIV may impact on the causes
      of liver-related death has never been investigated.

      The aim was to assess the relationship between age and
      cause of death in HCV-related cirrhotic patients
      according to the HIV coinfection.

      Patients and methods: 445 patients with histologically
      proven HCV cirrhosis had been consecutively seen
      between 1988 and 2001 and were followed for a median
      duration of 34 months (range:1-206 months). 54 were
      HIV positive. 95 had decompensated HCV cirrhosis at
      the time of liver biopsy. 261 received at least 3
      months of anti-HCV therapy during follow-up. The
      occurrence of the following complications was
      recorded: liver failure without HCC (LF), variceal
      bleeding (VB), hepatocellular carcinoma (HCC). Causes
      of death were recorded and classified as follows: non
      liver-related death, death from LF without HCC, death
      from VB without HCC and death from HCC. Statistical
      analyses were performed using chi-square and Kruskall
      Wallis rank tests.

      Results: Complications occurred during follow-up in
      191 patients (23 HIV positive): LF in 157 cases (22
      HIV positive), VB in 74 cases (9 HIV positive), and
      HCC in 64 cases (3 HIV positive). The prevalence of
      HCC was lower in HIV positive patients than in HIV
      negative patients (5.5% vs 15.6%, p=0.04). Death
      related to cirrhosis was observed in 71 cases (14 HIV
      positive). It represented 90% and 93% of the overall
      mortality in HIV negative and HIV positive patients,
      respectively (only one case of AIDS-related death).
      Causes of death were related to age. Before 60 years
      death was related to LF in 60%, to VB in 24% and to
      HCC in 16%. After 60 years, death was related to HCC
      in 64%, to LF in 27% and to VB in 3%.

      HIV positive patients died earlier (median: 46 vs 62
      years, p=0.002) and more often from LF (71% vs 39%,
      p=0.03) than from HCC or VB comparatively to HIV
      negative patients. When adjusted on the age these
      differences disappeared
      (table)

      Conclusion: In the course of HCV cirrhosis, the cause
      of liver-related death differs according to age.
      Because HIV positive patients got cirrhosis earlier,
      they die earlier and more often from liver failure,
      suggesting that HCV treatment should be initiated as
      soon as possible and liver transplantation discussed
      in non responders.


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