Progression of HIV infection and mortality by hepatitis C infection in patients with haemophilia over 20 years

Summary.  Hepatitis C virus (HCV) infection is an important cause of mortality in human immune deficiency virus (HIV)-positive haemophiliacs. This study describes progression to AIDS, death from HCV end-stage liver disease (ESLD) and all-cause mortality over 20 years. All HIV-positive haemophiliacs in La Paz University Hospital were included in this cohort. HIV seroconversion was estimated using mathematical techniques for interval-censored data from 1979 to 1985. Poisson regression was used to estimate rates of AIDS, death from ESLD and all causes in different periods: before 1988, 1988–89, 1990–91, 1992–93, 1994–95, 1996–97 and 1998–2001 using competing risk models. Among 383 cohort members, global AIDS incidence was 9.7 per 100 person-years, peaking in 1992–93 and dropping by 87% in 1998–2001 compared with before 1988 [incidence rate ratio (IRR) 0.13; 95% CI: 0.03–0.53]. Overall mortality was 7.5 per 100 person-years, was highest from 1992 to 1997, and fell by 66% in 1998–2001 compared with before 1988 (IRR 0.34; 95% CI: 0.14–0.81). Eighteen (5%) persons died of ESLD which represented 19% of deaths before 1988, 4% during 1988–89, 1990–91 and 1992–93, 2% in 1994–95, 10% in 1996–97 and 33% in 1998–2001. Overall death rate from ESLD was 0.5 cases per 100 person-years with no statistically significant trend observed over time. Important reductions in HIV disease progression to AIDS and death have been observed from 1998 to 2001, and can be attributed to highly active antiretroviral therapy. Although no increase in the rate of HCV-related deaths can be demonstrated, HCV accounts for an increasing proportion of deaths in the recent years.