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Temporal Trends in Liver-Related Mortality in a Prospective Cohort of
HIV-Infected Patients in Spain 1997-2008: HCV/HIV Coinfected Death Rates Increase While Rates Decline Among HCV-/HIV+
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Reported by Jules Levin
6th IAS July 17-20, 2011 Rome Italy
J. Berenguer1, B. Alejos2, V. Hernando2, P. Viciana3, J.A. Oteo4, J.L. Gomez Sirvent5, D. Dalmau6, J.Portilla7, S. Moreno8, J. Del Amo2, and CoRIS
1Hosp General Universitario Gregorio Maranon, Madrid, 2National Epidemiology Centre, ISCIII, Madrid, 3Hosp Virgen del Rocio, Sevilla, 4Hosp San Pedro-CIBIR, Logrono, 5Hosp Universitario de Canarias, Las Palmas, 6Hosp Mutua Tarrasa, Tarrasa, 7Hosp General de Alicante, Alicante, 8Hosp Ramon y Cajal, Madrid, Spain
"In the second period (2004-2008 vs 1997-2003) patients were more frequently free from HCV infection and had adcquired HIV infection predominantly by sex and not by IDU..... one can see a decline in overall and cause-specific mortality in HIV-infected patients in Spain..... we observed a significant decrease in overall death rate was observed among HCV negative patients whereas a non-significant increase was observed among HCV positive patients....... We observed a decrease in AIDS-related death rate in the limits of statiscal signifcance for HCV negatives, whereas AIDS-related death rates remained virtually unchanged among HCV positives"
"The leading causes in this category were cardiovascular conditions and non-AIDS defining malignancies followed by accidental poisoning, trauma, non-aids infection, suicide and other conditions"
ABSTRACT
Background: We have previously shown that the proportion of injection drug users (IDU) in CoRIS - a multicenter cohort of HIV+ cART naive adults in Spain - decreased from 67.3% in 1997 to 14.5% in 2006, with a parallel decrease in HCV coinfection prevalence; from 73.8% in 1997 to 19.8% in 2006. In this report, we aimed to evaluate trends in liverrelated mortality in HIV+ adults in CoRIS.
Methods: We analyzed data from CoRIS from 1997 to 2008 divided in 2 calendar periods: 1997-03 and 2004-08. Deaths were ascertained through cohort reporting and a cross-match with the Spanish National Death Index (NDI). We used NDI coding (based in IDC-9 and IDC-10) to categorize death as AIDS-related deaths, liver-related deaths (codes B15-B19, C22-C229, K70-K77, K922, K65, R18), and deaths due to other conditions. We used Poisson regression to model mortality rates and risk factors.
Results: Between 1997-2008, 6065 patients were included: 76% males, 31% IDU, 36% HCV+ (n=2,187), median age 35 yr, median CD4+ 335 cells/uL. During 19,416 person-years (PYs) of FU, 250 deaths were detected (death rate: 12.9/1,000 PYs). The table shows cause-specific death rates in both periods and crude incidence rate ratio (IRR) and 95% CI of death in period 2004-08 taking death rates in 1997-03 as reference. Results are stratified by HCV-status. Multivariate analyses did not change main findings.
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