Role of HIV Coinfection in Mortality Related to Hepatitis B or C By
Liz Highleyman Since
the advent of the HAART era, the mortality
rate associated with HIV disease has declined dramatically. Yet as mortality
due to opportunistic illnesses has decreased, liver disease has come
to account for a greater proportion of deaths in people with HIV; this is especially
true for patients with chronic viral hepatitis. As
reported at the recent 42nd
Annual Meeting of the European Association for the Study of the Liver (EASL) in Barcelona, French researchers conducted an analysis
to determine the role of HIV coinfection in deaths related
to hepatitis B virus (HBV) and hepatitis
C virus (HCV) infection. Among
all death certificates (53,1072) recorded in France in 2001,
34,839 mentioned HBV, HCV, hepatitis, liver disease, cirrhosis, bacterial infection,
HIV, and/or transplantation. From these, the investigators randomly selected 999.
A subsequent questionnaire asking about epidemiological, clinical, and virological
information was sent to the physicians who reported the deaths. 79% of forms were
adequately completed and independently analyzed by a panel of
hepatologists, who determined whether the deaths were related
to hepatitis B or C.
Results
- The estimated annual number of
deaths associated with HBV and HCV were 1507 and 3618, respectively.
- The estimated number of deaths
attributable to HBV and HCV were 1324 and 2646, respectively (2.2 and 4.5
deaths per 10,0000 habitants).
- Among HIV coinfected
individuals, the estimated number of deaths associated with HBV and HCV were 234
and 534, respectively.
- In coinfected
persons, 15% of deaths were associated with either HBV or HCV.
- Among patients with HIV-HCV coinfection, 79% were presumably infected via injection
drug use, 81% were being treatment for HIV, and 67% had never received treatment
for hepatitis.
- 17% presented with gastrointestinal
bleeding, 30% with encephalopathy, 34% with ascites, and 2% had hepatocellular
carcinoma.
- The mean age at death was significantly
younger in patients with HIV coinfection than in HIV
negative individuals (41 vs 70 years).
Conclusion
“The
study confirms the marked association between HIV and HCV- [or] HBV-related mortality
in France,
since about 15% of those who died with HCV or HBV infection were
also infected with HIV,” the researchers concluded. They
added that, “A major concern reported in this study is that HCV patients with
HIV coinfection had a mean age at death younger than patients
without HIV coinfection.” A majority of these patients
did not receive treatment for hepatitis. This
study, they wrote, emphasizes “the importance of HIV coinfection
in HCV or HBV patients as a major public health issue.” Hôpial Beaujon, Clichy,
France; Cépi-DC-INSERM, Vésinet,
France; Service DHépato-Gastroentérologie, Hôpital Albert Michallon, Grenoble, France; Service DHépato-Gastroentérologie,
Hôpital Jean Verdier, Bondy, France; Service DHépato-Gastroentérologie,
Hôpital Du Bocage, Dijon, France; Département
De Maladies Infectieuses, InVS,
Saint-Maurice, France. 04/24/07 Reference
T Asselah, F Pequignot,
J-P Zarski, and others. Role of HIV coinfection
in mortality related to hepatitis C and hepatitis B in France. 42 Annual Meeting of the European Association for the Study of the
Liver. Barcelona, Spain. April 11-15, 2007.
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