BackgroundMore than 10 years after the introduction of combination antiretroviral therapy (cART), we examined the trend in the proportion of deaths caused by end-stage liver disease (ESLD) in HIVinfected adults in France between 1995 and 2005. Design and methodsIn 2005, 34 departments prospectively recorded all deaths in HIV-infected patients who were followed in those departments (around 24 000). Results were compared with those of four previous cross-sectional surveys conducted since 1995 using the same methodology. ResultsAmong 287 reported deaths in 2005, 100 (35%) were related to AIDS, and 48 (17%) to ESLD. Three out of four patients who died from ESLD-related causes had chronic hepatitis C. Excessive alcohol consumption was reported in approximately half of the patients (48%). At death, 62% of patients had undetectable HIV viral load and the median CD4 count was 237 cells/mL. From 1995 to 2005, the proportion of deaths caused by ESLD increased from 2 to 17% (Po0.001). The proportion of deaths caused by hepatocellular carcinoma increased from 5% in 1995 to 25% in 2005 (P 5 0.0337). ConclusionsOver the 10 years from 1995 to 2005, the proportion of deaths caused by hepatitis C virus-related ESLD has increased in HIV-infected patients. ESLD is currently a leading cause of death in this population, with hepatocellular carcinoma representing a quarter of liver-related deaths. Recommendations for the detection of hepatocellular carcinoma should be strictly applied in these patients.Keywords: cirrhosis, hepatitis C virus, hepatocellular carcinoma, HIV, morbidity, mortality IntroductionThe widespread use of combination antiretroviral therapy (cART) in northern countries has increased life expectancy among individuals infected with HIV. The primary reason for this increased longevity is the decreasing rate of opportunistic infections which have often been a direct cause of death. Studies from single institutions have shown that liver disease caused by chronic hepatitis C virus (HCV) infection has become a significant cause of mortality among coinfected patients [1][2][3][4]. However, few studies have addressed the trends in mortality caused by HCV infection over a long period of time.In the last several years, the proportion of deaths caused by end-stage liver disease (ESLD) in French HIV-infected patients has progressively increased with time, and ESLD has become a leading cause of mortality [5][6][7]. This is likely to be related to prolonged longevity as a result of decreasing AIDS-related mortality, prolonged exposure to chronic HCV infection and high alcohol consumption. In parallel, large trials have demonstrated that HIV/HCVcoinfected patients may achieve a sustained virological response on combined treatment with pegylated interferon plus ribavirin, leading to histopathological improvement [8,9]. In daily clinical practice, continuing efforts to educate physicians and patients have increased access of HIV/HCV-coinfected patients to HCV treatment [10,11].In light of the critical role of time in the progressi...

BackgroundUrinary tract infections (UTIs) are among the most common bacterial infections. Despite this burden, there are few studies of the costs of UTIs. The objective of this study was to determine the costs of UTIs in women over 18 years of age who visit general practitioners in France.MethodsThe direct and indirect costs of clinical UTIs were estimated from societal, French National Health Insurance and patient perspectives. The study population was derived from a national cross-sectional survey entitled the Drug-Resistant Urinary Tract Infection (Druti). The Druti included every woman over 18 years of age who presented with symptoms of UTI and was conducted in France in 2012 and 2013 to estimate the annual incidence of UTIs due to antibiotic-resistant Enterobacteriaceae in women visiting general practitioners (GPs) for suspected UTIs.ResultsOf the 538 women included in Druti, 460 were followed over 8 weeks and included in the cost analysis. The mean age of the women was 46 years old. The median cost of care for one episode of a suspected UTI was €38, and the mean cost was €70. The annual societal cost was €58 million, and €29 million of this was reimbursed by the French National Health Insurance system. In 25 % of the cases, the suspected UTIs were associated with negative urine cultures. The societal cost of these suspected UTIs with negative urine cultures was €13.5 million. No significant difference was found between the costs of the UTIs due to antibiotic-resistant E. coli and those due to wild E. coli (p = 0.63).ConclusionIn the current context in which the care costs are continually increasing, the results of this study suggests that it is possible to decrease the cost of UTIs by reducing the costs of suspected UTIs and unnecessary treatments, as well as limiting the use of non-recommended tests.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1620-2) contains supplementary material, which is available to authorized users.

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