Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease
Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease
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DOI：
10.1097/01.aids.0000198087.47454.e1
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发表时间：
2006-01-02
期刊：
影响因子：
3.8
通讯作者：
Pineda, JA
中科院分区：
文献类型：
--
作者：
Merchante, N;Girón-González, JA;Pineda, JA
目的：为了找到丙型肝炎病毒（HCV）相关的终末期肝病（ESLD.Design and Methods）的HIV感染患者的生存率和死亡预测因素：一项前瞻性队列研究，在西班牙安达卢西亚的四家三级公立医院的传染病科。从2664例HIV/HCV共感染患者的多中心队列中，对1997年1月至2004年6月期间首次出现肝失代偿的所有HCV相关肝硬化患者进行随访，纳入153例患者。结果：随访期间死亡95例，死亡率62%。在79例（85%）患者中，死亡原因与肝脏有关。中位生存期13个月。生存率的独立预测因子是Child评分[危险比（HR），1.2; 95%置信区间（CI），1.08-1.37; P = 0.001]，失代偿时CD 4+细胞计数低于100个细胞/μ l（HR，2.48; 95% CI，1.52-4.06; P< 0.001）和肝性脑病为首次肝失代偿（HR，2.45; 95% CI，1.41-4.27; P = 0.001）。101例（66%）患者接受了HAART治疗。接受HAART治疗的患者1年和3年的累积生存概率分别为60%和40%，而未接受HAART治疗的患者分别为38%和18%（P < 0.0001）。HAART组死亡的HR（95% CI）为0.5（0.3-0.9），P = 0.03。结论：HIV/HCV合并感染的ESLD患者生存率极低。免疫抑制和严重肝病标志物可预测这些患者的肝脏相关死亡率。HAART似乎与肝脏相关死亡率降低有关。(C)2006年利平科特威廉姆斯&威尔金斯。
Objective: To find the survival and the predictors of death of HIV-infected patients with hepatitis C virus (HCV)-related end-stage liver disease (ESLD).Design and methods: A prospective cohort study set in the infectious diseases units of four tertiary care public hospitals in Andalucia, Spain. From a multicentric cohort of 2664 HIV/HCV-co-infected patients, all consecutive patients with HCV-related cirrhosis who presented with the first hepatic decompensation from January 1997 to June 2004 were followed-up and 153 patients were included. The survival and the demographic, HIV-related and liver-related factors associated with death were evaluated.Results: Ninety-five (62%) patients died during the follow-up. In 79 (85%) individuals, the cause of death was liver related. The median survival time was 13 months. independent predictors of survival were Child score [hazard ratio (HR), 1.2; 95% confidence interval (CI), 1.08-1.37; P = 0.001], CD4+ cell count at decompensation lower than 100 cells/mu l (HR, 2.48; 95% Cl, 1.52-4.06; P< 0.001) and hepatic encephalopathy as the first hepatic decompensation (HR, 2.45; 95% Cl, 1.41-4.27; P = 0.001). HAART was prescribed to 101 (66%) patients. The cumulative probability of survival in patients under HAART was 60% at 1 year and 40% at 3 years, versus 38 and 18%, respectively, in patients not treated with HAART (P < 0.0001). The HR (95% CI) of death in patients on HAART was 0.5 (0.3-0.9), (P = 0.03).Conclusions: The survival of HIV/HCV-co-infected patients with ESLD is extremely poor. Immunosuppression and markers of severe liver disease predict liver-related mortality in these patients. HAART seems to be associated with a reduced liver-related mortality. (C) 2006 Lippincott Williams & Wilkins.