French study finds low death rate due to hepatitis C virus in HIV-positive patients

French researchers reported in Clinical Infectious Diseases that the annual death rate from hepatitis C virus (HCV) is “very low” in HIV-positive patients and did not significantly change between 1995 and 1997. They noted, however, that during the same time frame that AIDS-related deaths decreased dramatically following the introduction of highly active antiretroviral therapy (HAART).

The reported findings are from a retrospective, multi-centre cohort study that utilized 2 patient surveys performed in France in 1995 and 1997. The surveys involved 17,487 and 26,947 HIV-positive patients in 1995 and 1997, respectively. In the 1997 survey, the overall prevalence of HCV was 16.8%, similar to the prevalence rates found in several other HIV-positive patient cohorts.

In 1995, 1,426 deaths occurred among the 17,847 patients surveyed, an overall mortality rate of 8.15%. 1,307 of these deaths were due to AIDS (91.5%), 21 to cirrhosis or hepatocellular carcinoma (1.5%) and 99 from other causes (7%). Of the 21 patients that died from cirrhosis during 1995, HCV alone or in conjunction with alcoholism was involved in 12 of those deaths.

In 1997, 543 deaths occurred among the 26,497 patients surveyed, an overall mortality rate of 2.04%. 459 of these deaths were due to AIDS (84.5%), 36 due to cirrhosis or hepatocellular carcinoma (6.5%), and 48 (9%) due to other causes. Of the 36 patients that died from cirrhosis during 1996, HCV alone or in conjunction with alcoholism was involved in 20 of those deaths.

The authors note that the only significant difference between the 1995 and 1997 surveys was the decrease in death due to AIDS, which was attributed to the use of HAART. The overall mortality rate due to cirrhosis or hepatocellular carcinoma remained stable at 0.12% in 1995 and 0.13% in 1997. However, it should be noted that among those HIV-positive patients who died in 1995 and 1997, the percentage of deaths due to cirrhosis or hepatocellular carcinoma increased from 1.5% in 1995 to 6.5% in 1997.

This findings of this study indicate that the overall incidence of death from cirrhosis and hepatocellular carcinoma remained “very low” and stable in HIV-infected patients between 1995 and 1997, however, due to the significant decrease in AIDS-related deaths, these conditions are becoming an increasingly important cause of mortality in HIV-positive patients. Accordingly, the prevention and treatment of HCV and other conditions that cause cirrhosis and hepatocellular carcinoma in HIV-positive patients will become increasingly important in the future in decreasing mortality in those patients.

P Cacoub and others. Mortality among Human Immunodeficiency Virus-Infected Patients with Cirrhosis or Hepatocellular Carcinoma Due to Hepatitis C Virus in French Departments of Internal Medicine/Infectious Diseases, in 1995 and 1997. Clinical Infectious Diseases. 2001; 32:1207-14.