Increasing impact of chronic viral hepatitis on hospital admissions and mortality among HIV-infected patients

To assess the impact of chronic viral liver disease (CVLD) on hospital admi ssions and death in HIV-infected patients since the introduction of highly active antiretroviral therapy, all hospital charts, from January 1996 to De cember 2000, in a large HIV/AIDS reference center in Madrid were reviewed. Discharge diagnosis, complications during the inpatient period, and number and causes of death were recorded. A total of 1334 hospital admissions invo lving 875 HIV-infected individuals was recorded. Up to 82% of them were eit her active or former intravenous drug users. Overall, 158 (11.8%) were admi tted because of complications of CVLD, or developed complications of CVLD d uring their admission for another reason. The absolute number and proportio n of admissions caused by CVLD increased over time, from 9.4% (31 of 330) i n 1996 to 16% (46 of 287) in 2000 (p<0.05). Likewise, the total number and proportion of deaths due to CVLD increased from 9.3% (5 of 54) in 1996 to 4 5% (9 of 20) in 2000 (p<0.05). Chronic hepatitis C was the only etiology in nearly three-quarters of patients who were admitted or died of CVLD. In co nclusion, the proportion of hospital admissions caused by liver failure in HIV-infected patients has increased in the last 5 years, accounting for 16% of cases in 2000. End-stage liver disease currently represents 45% of caus es of in-hospital death among HIV-infected individuals. Therefore, strategi es to prevent infection by hepatitis viruses (hepatitis B vaccine) and spec ific treatment (interferon plus ribavirin for hepatitis C virus) should be encouraged among HIV-infected persons.