Impact of chronic liver disease due to hepatitis viruses as cause of hospital admission and death in HIV-infected drug users

The life expectancy of HIV-positive individuals has been prolonged in recen t years, as a consequence of the wide use of antiretroviral drugs and prima ry prophylaxis for the most common opportunistic infections. In HIV-positiv e persons infected parenterally, chronic viral liver disease (CVLD), mainly that caused by hepatitis C virus (HCV). is frequently seen. Moreover, chro nic hepatitis C seems to present a more accelerated course in HIV-infected patients, leading to cirrhosis and liver failure in a shorter period of tim e. The aim of the present study was to investigate the impact of CVLD on th e morbidity and mortality of HIV-positive patients. A retrospective analysi s of the causes of hospital admission during a 4.5-year period in a referen ce centre for AIDS situated in Madrid was performed. Decompensated liver di sease (encephalopathy, ascites, jaundice), or complications directly relate d to it (gastrointestinal bleeding, hepatorenal syndrome, peritonitis) were diagnosed in 143 (8.6%) of 1670 hospital admissions. These episodes of CVL D corresponded to 105 different individuals, a quarter of whom had two or m ore re-admissions. HCV alone or in combination with other hepatotropic viru ses was involved in 93 (88.6%) patients admitted for CVLD. Death directly a ssociated with CVLD occurred in 15 individuals, which represented 4.8% of t he total causes of inhospital mortality during the study period, and repres ented the fifth cause of death in hospital for HIV-infected patients. In co nclusion, CVLD represents an important cause of hospital admission and deat h in HIV-infected drug users.