ObjectivesThe aim of this study was to describe the proportion of liver-related diseases (LRDs) as a cause of death in HIV-infected patients in France and to compare the results with data from our five previous surveys.
MethodsIn 2010, 24 clinical wards prospectively recorded all deaths occurring in around 26 000 HIV-infected patients who were regularly followed up. Results were compared with those of previous cross-sectional surveys conducted since 1995 using the same design.
ResultsAmong 230 reported deaths, 46 (20%) were related to AIDS and 30 (13%) to chronic liver diseases. Eighty per cent of patients who died from LRDs had chronic hepatitis C, 16.7% of them being coinfected with hepatitis B virus (HBV). Among patients who died from an LRD, excessive alcohol consumption was reported in 41%. At death, 80% of patients had undetectable HIV viral load and the median CD4 cell count was 349 cells/μL. The proportion of deaths and the mortality rate attributable to LRDs significantly increased between 1995 and 2005 from 1.5% to 16.7% and from 1.2‰ to 2.0‰, respectively, whereas they tended to decrease in 2010 to 13% and 1.1‰, respectively. Among liver-related causes of death, the proportion represented by hepatocellular carcinoma (HCC) dramatically increased from 5% in 1995 to 40% in 2010 (p = 0.019).
ConclusionsThe proportion of LRDs among causes of death in HIV-infected patients seems recently to have reached a plateau after a rapid increase during the decade 1995−2005. LRDs remain a leading
IntroductionAs a consequence of shared transmission routes, HIVinfected persons are at risk of other blood-borne and sexually transmitted infections. Hepatitis C virus (HCV) infection, which is predominantly transmitted parenterally, is common in this group. In northern countries, since the mid-1990s, several developments, such as the widespread use of combination antiretroviral therapy (cART) and better access to treatment for chronic hepatitis C, have contributed (1) to modifications of the natural history of chronic HCV infection in HIV-infected persons, and (2) to the emergence of liver-related diseases (LRDs) as a significant cause of mortality among coinfected individuals [1][2][3][4]. During the first decade following the advent of cART (1995−2005), the proportion of deaths attributable to LRDs in French HIV-infected patients has progressively increased and LRDs have become a leading cause of mortality [5][6][7][8]. This is likely to have been related to prolonged longevity as a result of decreasing AIDS-related mortality and longer exposure to chronic HCV infection. In parallel, large trials have demonstrated that HIV/HCV-coinfected patients may achieve a sustained virological response with combined treatment with pegylated interferon plus ribavirin, leading to histopathological improvement [9,10]. Continuing efforts to educate physicians and patients increased the access of HIV/HCV-coinfected patients to HCV treatment [11,12]. Finally, the eradication of HCV after therapy in HIV/HCV-coinfected patients is associate...
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log
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increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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