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End Stage Liver Disease Leading Cause of Death in HCV/HIV Coinfected in
France; 46% Had Cirrhosis; 37% had >200 Cd4s & <500 copies/ml viral load
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Abstract title: "Characteristics and Causes of Death in HIV-HCV Co-Infected
Patients (French Survey Mortalité 2000)". Abstract H-1719
S. DOMINIQUE, D. SALMON-CÉRON1, C. LEWDEN2, T. MAY3, F. BONNET4, L.
HERIPRET1, S. BEVILACQUA3, J. BOILEAU5; Cochin Hospital 27, Rue du Fbg St
Jacques, Paris, France
Among HIV+ adults deceased in France in 2000, we aimed at describing the main
characteristics of those coinfected with HCV. 185 French hospital wards
involved in the management of HIV infection prospectively notified all deaths
occurring in 2000 (among about 65,000 HIV-infected adults followed).
Underlying causes of deaths were documented from standardized questionnaires.
A total of 975 deaths were notified. Data of 774 cases were available for
analysis. HCV serology testing was positive in 240 patients (31%). In HIV-HCV
coinfected pts, end stage liver disease was the most frequent underlying
cause of death (33%). At the time of death, cirrhosis was present in 46% of
cases (n=105) and hepatocarcinoma in 4% (n=10). AIDS was the underlying cause
of death in 28%: NHL (n=14), LEMP (n=11), oesophageal candidiasis (n=11),
cerebral toxoplasmosis (n=9). Other causes included non AIDS-related cancer
(6%), bacterial infection (6%) cardiovascular disease (8%), drug overdose
(4%), suicide (4%). At time of death, CD4+ count was >200/mm3 in 38% pts,
HIV-RNA was < 500 cop/mL in 37%. When comparing causes of death in HCV+ and
HCV- pts, HCV+ pts were more likely to be in poor socio-economic conditions
(45% vs 28%), alcohol abusers (52% vs 19%), active drug abusers (31% vs 3%),
to have had a psychiatric disease (34% vs 20%), to be diagnosed earlier for
HIV (median: 10.9 vs 5.7 years), to have a higher CD4 cell count (142/mm3 vs
65/mm3) and a lower HIV-RNA (3.8 vs 4.7 log10 cop/mL). More pronounced trends
were found for patients with notified positive HCV RNA (60.5%). The study
authors concluded that HCV is the leading cause of death in HCV+HIV+
patients. Nearly half of death cases occurred at a relatively preserved
immunological condition. Therapies directed towards eradication of HCV virus
or slowing progression of fibrosis are urgently needed. The high proportion
of unfavorable socioeconomic and psychiatric conditions needs also special
attention.
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