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HIV coinfection shortens the survival of patients with hepatitis C virus‐related decompensated cirrhosis
Author(s) -
Pineda Juan A.,
RomeroGómez Manuel,
DíazGarcía Fernando,
GirónGonzález José A.,
Montero José L.,
TorreCisneros Julián,
Andrade Raúl J.,
GonzálezSerrano Mercedes,
Aguilar José,
AguilarGuisado Manuela,
Navarro José M.,
Salmerón Javier,
CaballeroGranado Francisco J.,
GarcíaGarcía José A.
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20626
Subject(s) - medicine , coinfection , decompensation , cirrhosis , gastroenterology , hepatitis c virus , contraindication , liver disease , hepatitis c , liver transplantation , hepatic encephalopathy , immunology , transplantation , virus , pathology , alternative medicine
Abstract The impact of human immunodeficiency virus (HIV) coinfection on the survival of patients with hepatitis C virus (HCV)‐related end‐stage liver disease (ESLD) is unknown. Because HIV infection is no longer considered an absolute contraindication for liver transplantation in some countries, it has become a priority to address this topic. The objective of this study was to compare the survival of HIV‐infected and HIV‐uninfected patients with decompensated cirrhosis due to HCV. In a retrospective cohort study, the survival of 1,037 HCV monoinfected and 180 HCV/HIV‐coinfected patients with cirrhosis after the first hepatic decompensation was analyzed. Of the group, 386 (37%) HCV‐monoinfected and 100 (56%) HCV/HIV‐coinfected subjects died during the follow‐up. The median survival time of HIV‐infected and HIV‐uninfected patients was 16 and 48 months, respectively ( P < .001). The relative risk (95% CI) of death for HIV‐infected patients was 2.26 (1.51‐3.38). Other independent predictors of survival were age older than 63 years (2.25 [1.53‐3.31]); Child‐Turcotte‐Pugh class B versus class A (1.95 [1.41–2.68]) and class C versus class A (2.78 [1.66–4.70]); hepatitis D virus infection (1.56 [1.12–4.77]); model for end‐stage liver disease score, (1.05 [1.01‐1‐11]); more than one simultaneous decompensation (1.23 [1.12–3.33]); and the type of the first hepatic decompensation, with a poorer prognosis associated with encephalopathy compared with portal hypertensive gastrointestinal bleeding (2.03 [1.26–3.10]). In conclusion , HIV coinfection reduces considerably the survival of patients with HCV‐related ESLD independently of other markers of poor prognosis. This fact must be taken into account to establish the adequate timing of liver transplantation in HIV‐coinfected subjects. (H EPATOLOGY 2005.)