IMPACT OF HIV COINFECTION ON THE AGE AND THE CAUSE OF DEATH IN PATIENTS WITH HCV CIRRHOSIS
- NATAP - www.natap.org
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
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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