Natural history of compensated viral cirrhosis in a cohort of patients with HIV infection

Raffaele Bruno, Paolo Sacchi, Massimo Puoti, Laura Maiocchi, Savino Patruno, Giampiero Carosi, Gaetano Filice

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The natural history of initially compensated cirrhosis in patients with HIV and concurrent hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is poorly defined. This study was designed to investigate the incidence and type of liver-related complications and mortality in coinfected cirrhotic patients. METHODS: We retrospectively identified a cohort of patients coinfected with HIV and HCV or HBV and initially compensated viral cirrhosis. Time to decompensation and mortality from liver-related causes were recorded. RESULTS: Between 1999 and 2004, 392 HIV-infected patients underwent a follow-up of ≥6 months. Sixty-nine patients (17.6%) with initially compensated cirrhosis were identified (7 HBV positive, 59 HCV positive, and 3 positive for both HBV and HCV). The most frequent complication was ascites. The mortality was 71.3 per 1000 person-years (95% confidence interval [CI], 47 to 108) in HIV-infected patients with HBV and/or HCV compensated cirrhosis, 8 (95% CI, 4 to 16) in HIV/HCV-coinfected patients without cirrhosis, and 6.5 (95% CI, 2.7 to 15.5) in HIV-monoinfected patients. After the first event of decompensation, the survival rate was 48% at 1 year and 18.1% at 3 years. Treatment with HAART after the first event of decompensation was associated with an increased survival rate (61.1% and 26.2% at 1 and 3 years, respectively, vs. 26.7% and 0%; P <0.0001). CONCLUSIONS: These results indicate significant morbidity and mortality during the 6 years after the diagnosis of compensated cirrhosis due to HBV and/or HCV in HIV-infected patients, identifying ascites as the most frequent complication.

Original languageEnglish
Pages (from-to)297-303
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume46
Issue number3
DOIs
Publication statusPublished - Nov 2007

Fingerprint

Natural History
HIV Infections
Fibrosis
Hepacivirus
Hepatitis B virus
HIV
Mortality
Confidence Intervals
Ascites
Survival Rate
Liver
Highly Active Antiretroviral Therapy
Virus Diseases
Morbidity
Incidence

Keywords

  • Cirrhosis
  • End-stage liver disease
  • HIV/HCV coinfection

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Natural history of compensated viral cirrhosis in a cohort of patients with HIV infection. / Bruno, Raffaele; Sacchi, Paolo; Puoti, Massimo; Maiocchi, Laura; Patruno, Savino; Carosi, Giampiero; Filice, Gaetano.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 46, No. 3, 11.2007, p. 297-303.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: The natural history of initially compensated cirrhosis in patients with HIV and concurrent hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is poorly defined. This study was designed to investigate the incidence and type of liver-related complications and mortality in coinfected cirrhotic patients. METHODS: We retrospectively identified a cohort of patients coinfected with HIV and HCV or HBV and initially compensated viral cirrhosis. Time to decompensation and mortality from liver-related causes were recorded. RESULTS: Between 1999 and 2004, 392 HIV-infected patients underwent a follow-up of ≥6 months. Sixty-nine patients (17.6{\%}) with initially compensated cirrhosis were identified (7 HBV positive, 59 HCV positive, and 3 positive for both HBV and HCV). The most frequent complication was ascites. The mortality was 71.3 per 1000 person-years (95{\%} confidence interval [CI], 47 to 108) in HIV-infected patients with HBV and/or HCV compensated cirrhosis, 8 (95{\%} CI, 4 to 16) in HIV/HCV-coinfected patients without cirrhosis, and 6.5 (95{\%} CI, 2.7 to 15.5) in HIV-monoinfected patients. After the first event of decompensation, the survival rate was 48{\%} at 1 year and 18.1{\%} at 3 years. Treatment with HAART after the first event of decompensation was associated with an increased survival rate (61.1{\%} and 26.2{\%} at 1 and 3 years, respectively, vs. 26.7{\%} and 0{\%}; P <0.0001). CONCLUSIONS: These results indicate significant morbidity and mortality during the 6 years after the diagnosis of compensated cirrhosis due to HBV and/or HCV in HIV-infected patients, identifying ascites as the most frequent complication.",
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AU - Bruno, Raffaele

AU - Sacchi, Paolo

AU - Puoti, Massimo

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AU - Patruno, Savino

AU - Carosi, Giampiero

AU - Filice, Gaetano

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N2 - BACKGROUND: The natural history of initially compensated cirrhosis in patients with HIV and concurrent hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is poorly defined. This study was designed to investigate the incidence and type of liver-related complications and mortality in coinfected cirrhotic patients. METHODS: We retrospectively identified a cohort of patients coinfected with HIV and HCV or HBV and initially compensated viral cirrhosis. Time to decompensation and mortality from liver-related causes were recorded. RESULTS: Between 1999 and 2004, 392 HIV-infected patients underwent a follow-up of ≥6 months. Sixty-nine patients (17.6%) with initially compensated cirrhosis were identified (7 HBV positive, 59 HCV positive, and 3 positive for both HBV and HCV). The most frequent complication was ascites. The mortality was 71.3 per 1000 person-years (95% confidence interval [CI], 47 to 108) in HIV-infected patients with HBV and/or HCV compensated cirrhosis, 8 (95% CI, 4 to 16) in HIV/HCV-coinfected patients without cirrhosis, and 6.5 (95% CI, 2.7 to 15.5) in HIV-monoinfected patients. After the first event of decompensation, the survival rate was 48% at 1 year and 18.1% at 3 years. Treatment with HAART after the first event of decompensation was associated with an increased survival rate (61.1% and 26.2% at 1 and 3 years, respectively, vs. 26.7% and 0%; P <0.0001). CONCLUSIONS: These results indicate significant morbidity and mortality during the 6 years after the diagnosis of compensated cirrhosis due to HBV and/or HCV in HIV-infected patients, identifying ascites as the most frequent complication.

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KW - End-stage liver disease

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