Liver‐related mortality in human‐immunodeficiency‐virus‐infected patients between 1995 and 2003 in the French GERMIVIC Joint Study Group Network (MORTAVIC 2003 Study)*

Abstract

The objective of the present study was to determine mortality because of end-stage liver disease (ESLD) in a nationwide population of HIV-infected patients, 7 years following the introduction of highly active antiretroviral therapy (HAART). All departments of internal medicine and infectious diseases from the GERMIVIC Study Group prospectively recorded all deaths in HIV-infected patients during 2003. Fifty-nine departments, following a total of 20 940 HIV-infected patients, participated in the study. Results were compared with those of previous surveys conducted using similar methodology in 1995, 1997 and 2001. Among 215 deaths observed during 2003, 101 (46.9%) were related to AIDS, 27 (12.6%) to ESLD and 87 (40.5%) to other causes. Mortality because of ESLD represented 23.7% of non-AIDS-related deaths. Patients dying from ESLD had chronic hepatitis because of hepatitis C virus (HCV) in 92.6% of cases and moderate (30-60 g) or high (>60 g) alcohol consumption (43.5% and 26.0%, respectively). In this population, deaths because of ESLD were 1.5% in 1995, 6.6% in 1997, 14.3% in 2001 and 12.6% in 2003. The prevalence of hepatocellular carcinoma as a cause of death remained high in 2003 but stable when compared with 2001 (25%vs 14.8%). Treatment of hepatitis C in patients who died from ESLD was more frequent in 2003 (44.4%) than in 2001 (26.3%). Seven years after the introduction of HAART, ESLD associated with HCV infections is a leading cause of mortality in HIV-infected patients, which did not increase between the years 2001 and 2003.

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

“…However, this has also meant that the causes of death have shifted to predominantly non AIDS-related diseases, with a high proportion of end-stage liver diseases being observed (2,(7)(8)(9)(10). These major hepatic complications have emerged in the context of excessive alcohol use -metabolic issues such as steatosis (11) and portal hypertension (12) may also be related to antiretroviral treatment toxicity but their role in liver mortality remains to be defined.…”

“…Several studies including the French national survey, "Mortalité 2000", have shown that complications of HCV and HBV are the second most frequent underlying cause of death after AIDS in HIV-infected patients, accounting for around 10% of deaths (1)(2)(3)(4).…”

“…In recent years, end stage liver disease has become a major cause of morbidity and mortality in patients chronically infected with the Human Immunodeficiency Virus (HIV) who are coinfected with hepatitis C (HCV) or B virus (HBV) (1)(2)(3)(4). This trend may be explained by a prolonged exposure to viral hepatitis, because most patients were infected with HCV in the 1980s.…”

HIV Co-Infection with Hepatotropic Viruses and Mycobacterial Tuberculosis

“…Co-infection s associated with a higher mortality than mono infection with either virus alone [46]. This liver-related mortality decreased following introduction of HAART (highly active antiretroviral therapy) [47]. Studies have shown that excessive consumption of alcohol appears to be a cofactor that increases mortality from liver disease in co-infected patients [40,47].…”

“…This liver-related mortality decreased following introduction of HAART (highly active antiretroviral therapy) [47]. Studies have shown that excessive consumption of alcohol appears to be a cofactor that increases mortality from liver disease in co-infected patients [40,47]. Most cases of liver associated mortality in co-infected patients are due to end-stage liver disease or hepato-cellular carcinomia [48].…”