Survival of HIV-infected Patients with Compensated Liver Cirrhosis

Survival of HIV-infected Patients with Compensated Liver Cirrhosis

Reported by Jules Levin
CROI 2010 Feb 16-19 SF

Paula Tuma*1, I Jarrin2, J del Amo2, E Vispo1, J Medrano1, L Martin-Carbonero1, P Labarga1, P Barreiro1, and V Soriano1

1Hosp Carlos III, Madrid, Spain and 2Inst de Salud Carlos III, Madrid, Spain


Background: Since the advent of HAART, liver-related mortality has become the leading cause of non-AIDS death in HIV+ patients. Complications of end-stage liver disease due to chronic hepatitis B and/or C are the main responsible for this observation. The current incidence and predictors of mortality in the subset of co-infected patients with compensated cirrhosis is not well known.


Methods: All HIV+ individuals on regular follow-up at one referral HIV clinic in Madrid who underwent at least one FibroScan evaluation were identified. Liver cirrhosis was defined for transient elastometry values >14.5 KPa. Mortality was checked in clinical records and at the National Death Registry. Predictors of death were examined using multivariate analysis. The prognostic value of 3 different tools (elastometry, Child-Pugh and MELD) for survival was assessed using Cox proportional models.


Results: From a total population of 1706 HIV+ individuals, 194 (11.4%) were cirrhotic and were prospectively followed since October 2004 until December 2008. Median follow-up was 2.35 years (IQR 1.4 to 5.5 years), which corresponded to 435 person-years of follow-up. Overall, 89% of cirrhotics had chronic hepatitis C, 10.3% chronic hepatitis B, 4.6% hepatitis delta, and 4.1% liver disease of other causes or unknown etiology. The overall mortality rate was 5.8 deaths per 100 patient-years. Multivariate analyses showed that age ≥50 years (hazard ratio (HR) = 4.76; 95%CI 1.66 to 13.59; P=0.004); CD4 counts <200 cells/mL (HR = 3.01; 95%CI 1.26 to 7.23; P =0.03) and detectable plasma HIV-RNA (HR = 3.97; 95%CI 1.53 to 10.27; P =0.005) were associated with mortality. A baseline MELD score ≥11 (log-rank test, P =0.03) and transient elastometry values >28.75 KPa (log-rank test, P =0.001) were independent predictors of mortality.


Conclusions: The death rate in HIV+ patients with compensated liver cirrhosis in the HAART era is 5.8% per year, higher than in previously reported HIV-negative individuals with cirrhosis (3 to 4%) or in non-cirrhotic HIV+ patients in the HAART era (<2%). Factors associated with increased mortality are older age, low CD4 counts, and detectable plasma HIV-RNA. This observation reinforces the current recommendation to provide HAART to all cirrhotic HIV+ patients regardless CD4 counts. Both MELD scores and especially transient elastometry values accurately predict mortality in this population.