Liver-related deaths in HIV-infected patients between 1995 and 2005 in the French GERMIVIC Joint Study Group Network (Mortavic 2005 Study in collaboration with the Mortalité 2005 survey, ANRS EN19)

Authors

  • E Rosenthal,

    1. Department of Internal Medicine, Archet Hospital Centre, University of Nice-Sophia Antipolis, Nice,
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  • D Salmon-Céron,

    1. Department of Internal Medicine, Cochin-Tarnier Hospital Centre, Paris,
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  • C Lewden,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
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  • V Bouteloup,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
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  • G Pialoux,

    1. Department of Infectious Diseases, Tenon Hospital, Paris,
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  • F Bonnet,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
    2. INSERM, Unit 593, Bordeaux,
    3. Department of Internal Medicine, Bordeaux University Hospital,
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  • M Karmochkine,

    1. Department of Internal Medicine, Georges Pompidou European Hospital, Paris,
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  • T May,

    1. Department of Infectious Diseases, Brabois University Hospital, Vandoeuvre-Les-Nancy,
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  • M François,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
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  • C Burty,

    1. Department of Infectious Diseases, Brabois University Hospital, Vandoeuvre-Les-Nancy,
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  • E Jougla,

    1. INSERM, CépiDc, Le Vésinet,
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  • D Costagliola,

    1. INSERM, Unit 720, Paris,
    2. Pierre et Maris Curie University, Paris and
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  • P Morlat,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
    2. INSERM, Unit 593, Bordeaux,
    3. Department of Internal Medicine, Bordeaux University Hospital,
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  • G Chêne,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 593, Victor Segalen University, Bordeaux 2, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux,
    2. INSERM, Unit 593, Bordeaux,
    3. Department of Internal Medicine, Bordeaux University Hospital,
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  • P Cacoub,

    1. Department of Internal Medicine, La Pitié Salpětrière Hospital Centre, Assistance Publique des Hǒpitaux de Paris and Centre National de la Recherche Scientifique, Unit 7087, Pierre et Marie Curie University, Paris, France
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  • the Mortavic/Mortalité 2005 Study Group

    1. Department of Internal Medicine, Archet Hospital Centre, University of Nice-Sophia Antipolis, Nice,
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  • *GERMIVIC, Joint Study Group on Hepatitis C Virus of the French National Society of Internal Medicine and the French Society of Infectious Diseases (see Appendix A); ANRS, Agence Nationale de Recherche sur le SIDA. Data were presented previously at the 58th Annual Meeting of the American Association for the Study of Liver Diseases, Boston, 2–6 November 2007 and published as an abstract in Hepatology 2007; 46: 296A (Abstract 135).

Professeur Eric Rosenthal, Service de Médecine Interne-Cancérologie, Hôpital Archet 1, 151 Route de Saint-Antoine de Ginestière, 06202 Nice Cedex 3, France. Tel: +33 492 035 824; fax: +33 492 035 896; e-mail: rosenthal.e@chu-nice.fr

Abstract

Background

More than 10 years after the introduction of combination antiretroviral therapy (cART), we examined the trend in the proportion of deaths caused by end-stage liver disease (ESLD) in HIV-infected adults in France between 1995 and 2005.

Design and methods

In 2005, 34 departments prospectively recorded all deaths in HIV-infected patients who were followed in those departments (around 24 000). Results were compared with those of four previous cross-sectional surveys conducted since 1995 using the same methodology.

Results

Among 287 reported deaths in 2005, 100 (35%) were related to AIDS, and 48 (17%) to ESLD. Three out of four patients who died from ESLD-related causes had chronic hepatitis C. Excessive alcohol consumption was reported in approximately half of the patients (48%). At death, 62% of patients had undetectable HIV viral load and the median CD4 count was 237 cells/μL. From 1995 to 2005, the proportion of deaths caused by ESLD increased from 2 to 17% (P<0.001). The proportion of deaths caused by hepatocellular carcinoma increased from 5% in 1995 to 25% in 2005 (P=0.0337).

Conclusions

Over the 10 years from 1995 to 2005, the proportion of deaths caused by hepatitis C virus-related ESLD has increased in HIV-infected patients. ESLD is currently a leading cause of death in this population, with hepatocellular carcinoma representing a quarter of liver-related deaths. Recommendations for the detection of hepatocellular carcinoma should be strictly applied in these patients.

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