LIVER-FAILURE AND MORTALITY IN HIV-POSITIVE HEMOPHILIACS - 14-YEAR EXPERIENCE AND LITERATURE-REVIEW

Progression to clinical liver failure has been observed in hepatitis C (HCV)-infected, HIV-seropositive haemophiliacs. We studied the record s of 176 haemophiliacs who were infected with HIV and/or HCV seen betw een 1980 and 1993. Thirty-two of 113 (28%) HIV-seropositive patients d ied during the study period. Ten of these patients died of liver failu re, representing 31% of all mortality. An additional four HIV-seroposi tive patients who died of other causes had end-stage liver disease. Cl inical liver failure occurred in 12% of the HIV-infected cohort. None of the HIV-seronegative, HCV-infected patients suffered from liver fai lure. Among HIV-infected patients, liver failure was associated with a dvanced age and decreased CD4 counts. Severe, sporadic ALT elevations were associated with liver failure; persistent transaminase elevations were associated with mortality. We conclude that HIV infection enhanc es progression of HCV infection to clinical liver failure, and that li ver failure is a major cause of mortality in HIV-positive haemophiliac s.