Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease

Abstract

Ninety-five (62%) patients died during the follow-up. In 79 (85%) individuals, the cause of death was liver related. The median survival time was 13 months. Independent predictors of survival were Child score [hazard ratio (HR), 1.2; 95% confidence interval (CI), 1.08-1.37; P = 0.001], CD4+ cell count at decompensation lower than 100 cells/microl (HR, 2.48; 95% CI, 1.52-4.06; P < 0.001) and hepatic encephalopathy as the first hepatic decompensation (HR, 2.45; 95% CI, 1.41-4.27; P = 0.001). HAART was prescribed to 101 (66%) patients. The cumulative probability of survival in patients under HAART was 60% at 1 year and 40% at 3 years, versus 38 and 18%, respectively, in patients not treated with HAART (P < 0.0001). The HR (95% CI) of death in patients on HAART was 0.5 (0.3-0.9), (P = 0.03). CONCLUSIONS The survival of HIV/HCV-co-infected patients with ESLD is extremely poor. Immunosuppression and markers of severe liver disease predict liver-related mortality in these patients. HAART seems to be associated with a reduced liver-related mortality.

Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus

“…25 The impact of immunosuppression on liver mortality is one reason for this recommendation. [2][3][4][5] In the present study, lack of control of HIV replication was a risk factor for progression. This is an additional reason to consider earlier ART initiation.…”

“…One of the cohorts was a collaboration of 11 centers, and the other cohort recruited patients from five centers from January 1997. 4,5 All individuals were evaluated at clinical visits scheduled every 3 months. Nine university hospitals participating in these cohorts followed 9,257 HIV/HCV-coinfected individuals from January 1986 to January 2008.…”

“…1 Low CD4 cell counts, lack of exposure to antiretroviral therapy (ART), and advanced liver disease are risk factors for liver events and mortality in cohort studies. [1][2][3][4][5] Particularly, CD4 cell recovery and suppression of HIV replication after starting highly active antiretroviral therapy (HAART) are predictors of survival free of complications of cirrhosis. 5 Most data on liver fibrosis progression in HIV and HCV coinfection come from cross-sectional studies that relied on a single liver biopsy.…”

Liver transplantation in human immunodeficiency virus-positive patients

“…In HIV-infected patients, the predictors of mortality after the first episode of decompensation include a high Child-Pugh score and hepatic encephalopathy as the presenting feature. 11 The manifestations of ESLD appear to be similar to those in HIV-negative patients, and survival after the first episode of decompensation is markedly reduced. 12 …”

Investigation of Plasma Biomarkers in HIV-1/HCV Mono- and Coinfected Individuals by Multiplex iTRAQ Quantitative Proteomics

“…Liver disease caused by HIV-1/HCV coinfection is characterized by increased liver fibrosis and cirrhosis. Several groups have observed that fibrosis progresses more rapidly in patient coinfected with HIV-1 and HCV (Gonzalez et al, 2003) and HCC develops more frequently and more quickly in HIVinfected individuals with HCV in comparison to HCV monoinfected patients Kramer et al, 2005;Merchante et al, 2006;Pineda et al, 2005). Recent screening studies have utilized known serum markers identified in HCV-infected patients to evaluate the progression of liver disease (Imbert-Bismut F, 2001;Rosenberg et al, 2004;Sumida et al, 2000;Suzman et al, 2008) and have shown correlation between elevated serum concentrations of alpha feto protein (AFP) and the occurrence of HCC (Chen et al, 1984) in coinfected patients.…”