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CAUSE & PREDICTORS OF MORTALITY IN AN HIV/HEPATITIS-C–COINFECTED COHORT IN SCOTLAND
Rebecca Metcalfe1, Gordon Proctor2, Joe Schofield3, Emma Thomson2
1Brownlee Cntr for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK,2Univ of Glasgow, Glasgow, UK,3Pub Hlth Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Cohort studies report the prevalence of HIV/hepatitis C (HCV) co-infection to range from 2.4% to 14% across the world and it is recognised that this group are associated with an increased all-cause and liver-related mortality when compared to HIV and HCV mono-infected patients. A few studies have reported on common causes of death in HIV/HCV co-infection but the results are conflicting. We sought to determine the common causes of mortality in our Scottish co-infected cohort and compare the characteristics of this group to the co-infected patients who remain in care, to determine predictive factors to all cause mortality.
A retrospective cohort review of all patients co-infected with HIV and HCV was carried out, covering a 15 year period. Hospital medical records, coroner records and national registry records were reviewed to collect data on those patients who had died. Data was complied on cause of death, HIV and liver related markers and compared with data of co-infected patients who have not died and statistical analysis performed.
Over 15 years, there were 45 deaths in the HIV/HCV cohort, with a total follow-up time of 540 years and an all-cause mortality rate of 7.78/100 person years. Figure 1 shows the number and primary cause of death recorded for this cohort. Of the drug related deaths, a prescribed opiate substitute (methadone) was a contributor in 93%. Factors that were found to be significant predictors of all cause mortality were low CD4 count, high HIV viral load and even in patients not recorded as having had a liver-related death, lower albumin, higher bilirubin levels* and prolonged INR. *when atazanavir use was excluded
In this study we found that drug related causes were the most common cause of death (31%) in HIV/hepatitis C co-infected patients. Other infections were responsible in 16% and liver-related deaths and HIV/AIDs were responsible for only 11%. We found that liver biochemistry markers can be used to determine risk of all-cause mortality in HIV/HCV co-infected patients and this suggests that liver dysfunction may adversely impact on the likelihood of overdose (even when not recorded as a contributor to death). The majority of drug related deaths were due to a prescribed opiate substitute which raises concerns about opiate prescribing in those with HIV/HCV co-infection.