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All-cause Mortality in HIV-infected Patients in Spain Compared to the General Population according to HCV Status: HIV increases death risk 2.5 times, HCV coinfection increases death risk 11 times higher
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Reported by Jules Levin
CROI Feb 16-19 2010 SF
Santiago Perez Cachafeiro*1, C Lewden2, V Hernando1, J A Iribarren3, J A Oteo4, J L Gomez Sirvent5, J Hernandez Quero6, M Masia7, S Moreno8, J Del Amo1, and CoRIS/CoRIS-MD
1Hosp Carlos III, Madrid, Spain; 2INSERM U897, Univ Bordeaux 2, France; 3Hosp Donostia, San Sebastian, Spain; 4Hosp San Pedro, La Rioja, Spain; 5Hosp Univ Canarias, Tenerife, Spain; 6Hosp Univ San Cecilio, Granada, Spain; 7Hosp Univ Elche, Spain; and 8Hosp Univ Ramon y Cajal, Madrid, Spain
AUTHOR CONCLUSION:
Our study has found a large impact of HCV coinfection on the mortality of HIV-positive subjects over a 10 year period. We show that mortality in people with HIV/HCV coinfection is 11 times higher than that of the general population of the same age and gender in Spain , while being monoinfected with HIV is associated with a two and a half increase
ABSTRACT
Background: Hepatitis C virus (HCV) may increase the risk of death HIV-positive people compared to the general population. We aim to compare all-cause mortality rates in HIV-positive patients with rates from the general population according to HCV status.
Methods: Data from 2 open Spanish multicenter hospital-based cohorts; CoRIS-MD, a retrospectively assembled cohort from January 1997 to December 2003, and CoRIS, a prospective cohort from January 2004 to November 2008 were analyzed. Subjects naïve to HAART at entry, with an HCV test and at least 6 moths of follow-up were eligible for analyses. Standardized mortality ratios (SMR) were estimated compared to age and sex specific mortality rates from Spanish general populations from the National Institute of Statistics last available by December 2007, date of administrative censoring.
Results: Overall, 5,377 subjects were included; 75.4% men, 33.2% injecting drug users (IDU), 30.7% MSM, median age 35 years, median CD4 count at entry was 353 (interquartile range 140 to 556). There were 204 deaths recorded in 16,513 person-years, yielding a mortality rate of 1.2% (95%CI 1.1 to 1.4). 55 deaths occurred among 3,256 HCV-negative subjects (8,346 person-years) and 149 deaths among the 2,121 HCV-positive subjects (8,167 person-years). SMR for HCV-negative subjects was 2.6 (95%CI 2.0 to 3.3) and 11.1 (95%CI 9.4 to 13.1) for HCV-positive subjects. Among HCV-negative subjects, SMR were 2.3 (95%CI 1.7 to 3.0) for men and 5.2 (95%CI 3.0 to 9.0) for women; 2.6 (95%CI 1.8 to 3.9) for heterosexuals, 8.5 (95%CI 4.0 to 18.0) for IDU and 2.3 (95%CI 1.5 to 3.5) for MSM, 5.0 (95%CI 2.1 to 12.1) for subjects of 18 to 29 years, 3.6 (95%CI 1.6 to 8.1) for 30 to 34, 2.2 (95%CI 0.9 to 5.21) for 35 to 39, and 2.4 (95%CI 1.7 to 3.2) for 40 or more. SMR for HCV-positive subjects were 10.2 (95%CI 8.6 to 12.2) for men and 18.1 (95%CI 12.4 to 26.3) for women; 7.8 (95%CI 4.5 to 13.4) for heterosexuals, 12.5 (95%CI 10.5 to 14.8) for IDU and 5.5 (95%CI 1.8 to 16.9) for MSM, 7.0 (95%CI 2.6 to 18.6) for subjects of 18 to 29 years, 14.5 (95%CI 10.0 to 21.0) for 30 to 34, 11.22 (95%CI 8.5 to 14.8) for 35 to 39, and 10.33 (95%CI 8.1 to 13.1) for 40 or more.
Conclusions: HIV infection alone is associated with a double risk of death compared to the general population of the same age and sex, but being also co-infected by HCV increases this risk to 11. SMR are markedly higher for women and IDU for both HCV-negative and positive subjects.
Table1. Death rates of the study population and SMR compared to Spanish general population
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