Liver Complications Have Reached a Plateau as Cause of Hospital Admission and Death in HIV Patients in Madrid

Nuñez-Fernández, Carla; Martín-Carbonero, Luz; Valencia, Eulalia; Aguilera, Juan; García-Samaniego, Javier; González-Lahoz, Juan; Soriano, Vincent

doi:10.1089/aid.2008.0242

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…Other studies have demonstrated the increasing impact of chronic viral hepatitis and liver disease on hospital admission rates [22,25-27]. Prevention of hepatitis co-infection, timely treatment of chronic viral hepatitis in HIV co-infected patients, and careful monitoring of treatment related hepatotoxicity are important measures to reduce liver-related complications and subsequent hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000–2008: hospital-based cohort studies

et al. 2014

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BackgroundIn high-income settings, the spectrum of morbidity and mortality experienced by Human Immunodeficiency Virus (HIV)-infected individuals receiving combination antiretroviral therapy (cART) has switched from predominantly AIDS-related to non-AIDS-related conditions. In the context of universal access to care, we evaluated whether that shift would apply in Brazil, a middle-income country with universal access to treatment, as compared to France.MethodsTwo hospital-based cohorts of HIV-infected individuals were used for this analysis: the ANRS CO3 Aquitaine Cohort in South Western France and the Evandro Chagas Research Institute (IPEC) Cohort of the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Severe morbid events (AIDS- and non-AIDS-related) were defined as all clinical diagnoses associated with a hospitalization of ≥48 hours. Trends in the incidence rate of events and their determinants were estimated while adjusting for within-subject correlation using generalized estimating equations models with an auto-regressive correlation structure and robust standard errors.ResultBetween January 2000 and December 2008, 7812 adult patients were followed for a total of 41,668 person-years (PY) of follow-up. Throughout the study period, 90% of the patients were treated with cART. The annual incidence rate of AIDS and non-AIDS events, and of deaths significantly decreased over the years, from 6.2, 21.1, and 1.9 AIDS, non-AIDS events, and deaths per 100 PY in 2000 to 4.3, 14.9, and 1.5/100 PY in 2008. The annual incidence rates of non-AIDS events surpassed that of AIDS-events during the entire study period. High CD4 cell counts were associated with a lower incidence rate of AIDS and non-AIDS events as well as with lower rates of specific non-AIDS events, such as bacterial, hepatic, viral, neurological, and cardiovascular conditions. Adjusted analysis showed that severe morbidity was associated with lower CD4 counts and higher plasma HIV RNAs but not with setting (IPEC versus Aquitaine).ConclusionsAs information on severe morbidities for HIV-infected patients remain scarce, data on hospitalizations are valuable to identify priorities for case management and to improve the quality of life of patients with a chronic disease requiring life-long treatment. Immune restoration is highly effective in reducing AIDS and non-AIDS severe morbid events irrespective of the setting.

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Section: Discussionmentioning

confidence: 99%

AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000–2008: hospital-based cohort studies

et al. 2014

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“…Our study suggests that liver disease, and perhaps cardiovascular diseases and cancers, are increasingly important reasons for hospitalization. Other studies have demonstrated the increasing impact of chronic viral hepatitis and liver disease on admission rates [2, 5, 25–28], including one study that showed nearly 10% of admissions and one-third of in-hospital deaths were due to liver disease [29]. Many studies focused on the importance of hepatitis C virus on the increasing hospitalization rates of liver disease [2, 28]; of note, we found increasing rates of liver disease despite an overall low prevalence of hepatitis C among our cohort.…”

Section: Discussionmentioning

confidence: 99%

Trends and Causes of Hospitalizations Among HIV-Infected Persons During the Late HAART Era: What Is the Impact of CD4 Counts and HAART Use?

Crum-Cianflone¹,

Grandits²,

Echols³

et al. 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes

105

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Background Declining rates of hospitalizations occurred shortly after the availability of HAART. However, trends in the late HAART era are less defined, and data on the impact of CD4 counts and HAART use on hospitalizations are needed. Methods We evaluated hospitalization rates from 1999–2007 among HIV-infected persons enrolled in a large U.S. military cohort. Poisson regression was used to compare hospitalization rates per year and to examine factors associated with hospitalization. Results Of the 2,429 participants, 822 (34%) were hospitalized at least once with 1,770 separate hospital admissions. The rate of hospitalizations (137 per 1,000 PYs) was constant over the study period (relative rate, RR 1.00 per year change, 95% CI, 0.98–1.02). The hospitalization rates due to skin infections (RR 1.50, p=0.02), MRSA (RR 3.19, p=0.03), liver disease (RR 1.71, p=0.04), and surgery (RR 1.17, p=0.04) significantly increased over time, while psychological causes (RR 0.60, p<0.01) and trauma (RR 0.54, p<0.01) decreased. In the multivariate model, higher nadir CD4 (RR 0.92 per 50 cells, P<0.01) and higher proximal CD4 counts (RR of 0.71 for 350–499 vs. <350 cells/mm3 and RR 0.67 for >500 vs. <350 cells/mm3, both P<0.01) were associated with lower risk of hospitalization. Risk of hospitalization was constant for proximal CD4 levels above 350 (RR 0.94 P=0.51, CD4 ≥500 vs. 350–499). HAART was associated with a reduced risk of hospitalization among those with a CD4 <350 (RR 0.72, P=0.02), but had smaller estimated and non-significant effects at higher CD4 levels (RR 0.81, P=0.33 and 1.06, P=0.71 for CD4 350–499 and ≥500, respectively). Conclusions Hospitalizations continue to occur at high rates among HIV-infected persons with increasing rates for skin infections, MRSA, liver disease, and surgeries. Factors associated with a reduced risk of hospitalization include CD4 counts >350 cells/mm3 and HAART use among patients with a CD4 count <350 cells/mm3.

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“…In contrast with other cohorts, hepatitis C therapy had been given to a relatively high proportion (41%) of HIV/HCV coinfected patients in our cohort. In parallel with this wide use of hepatitis C therapy and associated benefit in terms of HCV clearance in a fraction of treated patients (42% in our cohort), we recently begun to appreciate that hospital admissions and deaths owing to HCV‐related liver disease have stabilized at our clinic [20]. The relatively large uptake of hepatitis C therapy in our cohort contrasts with rates below 10% in studies performed in North America [21,22], but it is in agreement with what is currently seen in other European countries [19,23,24].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus (HCV) treatment uptake and changes in the prevalence of HCV genotypes in HIV/HCV‐coinfected patients

Medrano

Resino

Vispo

et al. 2011

Journal of Viral Hepatitis

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The efficacy of current hepatitis C therapy in HIV/HCV-coinfected patients is largely dependent on HCV genotype. The annual prevalence of HCV genotypes/subtypes and their influence on HCV clearance with antiviral treatment were examined in a dynamic cohort of HIV/HCV-coinfected patients followed up in Madrid since 2000. Patients entered the cohort at first visit and left the cohort when HCV clearance was achieved with HCV therapy or when follow-up was interrupted for any reason, including death. A total of 672 HIV/HCV-coinfected patients constituted the cohort. The mean follow-up time was 5.5 years, corresponding to 4108 patient-years. Mean age at entry was 37 years, and 73% were men and 86% were intravenous drug users. Overall distribution of HCV genotypes was as follows: 57.1% HCV-1 (1a: 29.2%, 1b: 20.4%, unknown: 7.6%), 1.3% HCV-2, 25.4% HCV-3 and 15.9% HCV-4. A total of 274 (40.8%) patients were treated with peginterferon-ribavirin, of whom 116 (42.3%) achieved HCV clearance following 1-3 courses of therapy. The proportion of HCV-1/4 rose from 71.7% in 2000 to 76.8% in 2008, whereas the proportion of HCV-2/3 fell from 28.1% in 2000 to 23.2% in 2008. The yearly prevalence increased for HCV-1 (R(2) : 0.92, b: 0.59, P < 0.001) and HCV-4 (R(2) : 0.77, b: 0.33, P < 0.005) and conversely diminished for HCV-3 (R(2) : 0.94, b: -0.82, P < 0.001). In summary, the prevalence of HCV-1 and HCV-4 has increased over the last decade in HIV/HCV-coinfected patients, whereas conversely it has declined for HCV-3, in association with the wider use of HCV therapy (41%) in this population.

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Liver Complications Have Reached a Plateau as Cause of Hospital Admission and Death in HIV Patients in Madrid

Cited by 8 publications

References 15 publications

AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000–2008: hospital-based cohort studies

AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000–2008: hospital-based cohort studies

Trends and Causes of Hospitalizations Among HIV-Infected Persons During the Late HAART Era: What Is the Impact of CD4 Counts and HAART Use?

Hepatitis C virus (HCV) treatment uptake and changes in the prevalence of HCV genotypes in HIV/HCV‐coinfected patients

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