European Journal of Epidemiology

, Volume 15, Issue 1, pp 1–4

Impact of chronic liver disease due to hepatitis viruses as cause of hospital admission and death in HIV-infected drug users

  • V. Soriano
  • J. García-samaniego
  • E. Valencia
  • R. Rodríguez-rosado
  • F. Muñoz
  • J. González-lahoz
Article

Abstract

The life expectancy of HIV-positive individuals has been prolonged in recent years, as a consequence of the wide use of antiretroviral drugs and primary prophylaxis for the most common opportunistic infections. In HIV-positive persons infected parenterally, chronic viral liver disease (CVLD), mainly that caused by hepatitis C virus (HCV), is frequently seen. Moreover, chronic hepatitis C seems to present a more accelerated course in HIV-infected patients, leading to cirrhosis and liver failure in a shorter period of time. The aim of the present study was to investigate the impact of CVLD on the morbidity and mortality of HIV-positive patients. A retrospective analysis of the causes of hospital admission during a 4.5-year period in a reference centre for AIDS situated in Madrid was performed. Decompensated liver disease (encephalopathy, ascites, jaundice), or complications directly related to it (gastrointestinal bleeding, hepatorenal syndrome, peritonitis) were diagnosed in 143 (8.6%) of 1670 hospital admissions. These episodes of CVLD corresponded to 105 different individuals, a quarter of whom had two or more re- admissions. HCV alone or in combination with other hepatotropic viruses was involved in 93 (88.6%) patients admitted for CVLD. Death directly associated with CVLD occurred in 15 individuals, which represented 4.8% of the total causes of inhospital mortality during the study period, and represented the fifth cause of death in hospital for HIV-infected patients. In conclusion, CVLD represents an important cause of hospital admission and death in HIV-infected drug users.

Drug users Hepatitis B Hepatitis C Human immunodeficiency virus (HIV) Liver Natural history Viral hepatitis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Moore R, Hidalgo J, Sugland B, Chaisson R. Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med 1991; 324: 1412–1416.Google Scholar
  2. 2.
    Vella S, Giuliano M, Pezzotti P. Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients. JAMA 1992; 267: 1232–1236.Google Scholar
  3. 3.
    Haverkos H, Lange W. Serious infections other than HIV among intravenous drug abusers. J Infect Dis 1990; 161: 894–902.Google Scholar
  4. 4.
    Sabin C, Phillips A, Elford J, Griffiths P, Janossy G, Lee C. The progression of HIV disease in a haemophiliac cohort followed for 12 years. Br J Haematol 1993; 83: 330–333.Google Scholar
  5. 5.
    Lee C, Sabin C, Phillips A, Elford J, Pasi J. Morbidity and mortality from transfusion-transmitted disease in haemophilia. Lancet 1995; 345: 1309.Google Scholar
  6. 6.
    Jover R, Gutiérrez A, Boix V, Portilla J. Mortality caused by chronic liver disease in HIV-infected patients. Med Clin (Barc) 1995; 105: 48.Google Scholar
  7. 7.
    Martin P, Di Bisceglie A, Kassianides C, Lisker-Melman M, Hoofnagle J. Rapidly progressive Non-A, Non-B hepatitis in patients with HIV infection. Gastroenterology 1989; 97: 1559–1561.Google Scholar
  8. 8.
    Telfer P, Sabin C, Devereux H, Scott F, Dusheiko G, Lee C. The progression of HCV-associated liver disease in a cohort of haemophilia patients. Br J Haematol 1994; 87: 555–561.Google Scholar
  9. 9.
    Eyster M, Diamondstone L, Lien J, Ehmann W, Quan S, Goedert J. The natural history of hepatitis C virus (HCV) infection in multitransfused hemophiliacs: Effect of coinfection with HIV. J AIDS Hum Retrovirol 1993; 6: 602–610.Google Scholar
  10. 10.
    Sánchez-Quijano A, Andreu J, Gavilán F, et al. Influence of HIV type 1 infection on the natural course of chronic parenterally acquired hepatitis C. Eur J Clin Microbiol Infect Dis 1995; 14: 949–953.Google Scholar
  11. 11.
    Soriano V, García-Samaniego J, Bravo R, et al. Morbidity and mortality with chronic viral liver disease in HIV-infected patients. Med Clin (Barc) 1995; 104: 641–644.Google Scholar
  12. 12.
    Phillips A, Sabin C, Elford J, Bofill M, Janossy G, Lee C. Use of CD4 lymphocyte count to predict long-term survival free of AIDS after HIV infection. BMJ 1994; 309: 309–313.Google Scholar
  13. 13.
    Thomas D, Vlahov D, Solomon L, et al. Correlates of hepatitis C virus infections among injection drug users. Medicine (Baltimore) 1995; 74: 212–220.Google Scholar
  14. 14.
    De Pouplana M, Soriano V, García-Samaniego J, Enríquez A, Muñoz F, González-Lahoz J. More severe course of Delta hepatitis in HIV-infected patients. Genitourin Med 1995; 71: 132–133.Google Scholar
  15. 15.
    Soriano V, Valencia E, Alba A, et al. Changing spectrum of diseases in hospitalized patients with HIV infection. Med Clin (Barc) 1993; 101: 736–740.Google Scholar
  16. 16.
    Montaner J, Le T, Hogg R, et al. The changing spectrum of AIDS index diseases in Canada. AIDS 1994; 8: 693–696.Google Scholar
  17. 17.
    Soto B, Sánchez-Quijano A, Rodrigo L, et al. HIV infection modifies the natural history of chronic parenterally acquired hepatitis C with an unusually rapid progression to cirrhosis. A multicenter study on 547 patients. J Hepatol 1997; 26: 1–5.Google Scholar
  18. 18.
    Rodríguez-Rosado R, Gacía-Samaniego J, Soriano V. Hepatotoxicity after introduction of highly active antiretroviral therapy. AIDS 1998; 12: 1256.Google Scholar
  19. 19.
    Soriano V, García-Samaniego J, Bravo R, et al. Interferon alfa for the treatment of chronic hepatitis C in patients infected with human immunodeficiency virus. Clin Infect Dis 1996; 23: 585–591.Google Scholar
  20. 20.
    National Institutes of Health. Consensus Development Conference Panel Statement: Management of hepatitis C. Hepatology 1997; 26(Suppl. 1): 2–10.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • V. Soriano
    • 1
  • J. García-samaniego
    • 2
  • E. Valencia
    • 1
  • R. Rodríguez-rosado
    • 1
  • F. Muñoz
    • 2
  • J. González-lahoz
    • 1
  1. 1.Service of Infectious Diseases, Centro de Investigaciones ClínicasInstituto de Salud Carlos IIIMadridSpain
  2. 2.Service of Hepatology, Centro de Investigaciones ClínicasInstituto de Salud Carlos IIIMadridSpain

Personalised recommendations