3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

CLINICAL CHARACTERISTICS AND OUTCOME OF DECOMPENSATED LIVER CIRRHOSIS IN HIV-INFECTED PATIENTS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe1.1C08

Euba G., Shaw E., Castellote J.1, Xiol X., Podzamczer D., Santin M.
IDIBELL Hospital Universitari Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain

INTRODUCTION: In the last years, liver disease has emerged as a leading cause of morbidity and mortality in HIV-infected patients (pts). The aim of this study is to describe clinical characteristics and outcome of HIV pts with decompensated liver cirrhosis.

METHODS: A retrospective study of 110 HIV pts followed between 1990 and 2003, who developed decompensated liver disease. Pts were classified into two groups according to the first decompensation date: period A from 1990 to 1996 (pre-HAART) and period B from 1997 to 2003 (HAART). Survival was assessed by Kaplan-Meier method.

RESULTS: 110 pts were studied (Period A: 48. Period B: 62). 81% had hepatitis C virus and 34.5% active hepatitis B virus infection. Most frequent initial events were ascitis (89%), hepatic encephalopaty (19%), gastrointestinal bleeding (7%) and spontaneous bacterial peritonitis (6.8%). Patients from period A comparing to period B were younger (32 vs. 38 yrs, p<0.01), were less frequently on antiretroviral therapy (29% vs. 56%, p=0.012) and had lower CD4 cell count (mean 134 vs. 197, p=0.09). No differences were found in risk for HIV, cause of cirrhosis, Child-Pugh at first decompensation or complications during follow up. Overall median survival from liver decompensation was 6 months. Cumulative survival at 12 months was 35% for period A and 34% for B (log-rank test p=0.85). According to Child-Pugh at first decompensation, median survival was 8.5 months for pts with Child-Pugh B and 4.2 months for Child-Pugh C (p<0.01). Death was related to liver disease in 60% of cases in period A and 81.8% in period B (p= 0.024 ).

CONCLUSIONS: Decompensated liver cirrhosis implies a poor prognosis in HIV-infected pts. In the HAART era, mortality of HIV-cirrhotic pts is mostly related to liver disease. Due to the short survival after decompensation occurs, liver transplantation should be considered as soon as possible in these pts.

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050724
Clinical | TuPe1.1C08 | Gorane Euba
Hepatitis viruses

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