Natural history of compensated and decompensated HCV-related cirrhosis in HIV-infected patients: A prospective multicentre study

Abstract

Objective: To define the course of HIV-HCV-coinfected patients with compensated and decompensated liver cirrhosis and to investigate the survival and the risk factors for death. Patients and methods: Ninety-two HIV-infected patients with HCV-related cirrhosis (50 of them without and 42 with previous decompensations) were prospectively followed up during a median period of 20 months. Clinical, biochemical, virological and immunological factors were analysed. Multivariate analyses were performed of those factors associated with decompensations and mortality. Results: There were 168 readmissions due to liver-disease-related causes. A Child-Pugh index ≥6 in those without previous decompensations (hazard ratio [HR] 7.94, 95% confidence interval [CI] 1.59-39.58; P=0.014), and Child-Pugh index ≥9 (HR 2.68, 95% CI 1.13-6.33; P=0.003) and absence of HAART (HR 0.44, 95% CI 0.19-0.98; P=0.048) in those with previous decompensations were independently associated with decompensation during the follow up. There were 27 deaths, 22 of them attributable to liver disease. Independent factors associated with liver-related mortality were a Child-Pugh index ≥9 (HR 6.24, 95% CI 2.31-16.85; p<0.001), progression of Child-Pugh index during the follow up (HR 4.27, 95% CI 1.54-11.80; P=0.008), more than one decompensation (HR 24.25, 950/0 CI 7.27-40.45; P<0.001) and absence of HAART (HR 0.35, 95% CI 0.12-0.98; P=0.002). Conclusions: Evolution from compensated to decompensated cirrhosis and death is influenced by markers of liver function and the absence of HAART. The importance of this last element must be adequately stressed. © 2007 International Medical Press.