To assess the impact of HIV and hepatitis C virus (HCV) infection on long-term mortality in injecting drug users (IDU).
Community-based prospective cohort study.
Mortality data from follow-up in ...clinical sites and the Mortality Registry by December 2002 were collected for 3247 IDU who attended three centres for voluntary counselling and testing for HIV/AIDS, HCV and hepatitis B virus (HBV) in 1990-1996. Mortality rates by Poisson regression were adjusting for age, sex, duration of drug use, education, HBV and calendar period (1990-1997 and 1998-2002).
Overall, 11.2% were HIV/HCV negative, 43.7% positive only for HCV and 45.1% positive for both. During 26 772 person-years of follow-up, 585 deaths were detected (2.19/100 person-years). Before 1997, HIV/HCV-positive subjects had a five-fold increase in risk of death relative risk (RR), 5.4; 95% confidence interval (CI), 2.5-11.4 compared with those negative for both; after 1997, a three-fold increase was observed (RR, 2.7; 95% CI, 1.7-4.2). Being HCV positive/HIV negative was not associated with an increase in the risk of death either before (RR, 1.3; 95% CI, 0.6-2.9) or after (RR, 1.2; 95% CI, 0.8-1.9) 1997 compared with HCV/HIV negative. While increases in mortality were seen in those HCV/HIV negative (RR, 1.6; 95% CI, 0.7-3.7) and those only positive for HCV (RR, 1.5; 95% CI, 1.0-2.1), a 20% reduction among coinfected IDUs was observed after 1997 (interaction P = 0.033).
HCV/HIV coinfection has had a large impact on mortality in IDU. After 1997, mortality increased in HIV negative/HCV positive subjects and decreased in HIV positive/HCV positive.
Hepatitis C virus (HCV) is the most common blood-borne infection in developed countries and co-infection with the Human Immunodeficiency Virus (HIV) is frequent in individuals with history of ...injecting drug use (IDU).We aimed to analyze liver transaminases in HCV monoinfected and HCV/HIV co-infected patients to assess the effect of HIV infection on liver enzyme elevations.We studied 429 current IDUs admitted to substance abuse treatment (82.5% males). Serum samples for liver tests, HIV infection and viral hepatitis serologies were obtained at admission.
Median age was 30 years (IQR:27-34), median duration of IDU was 10 years (IQR:5-14), 52% of patients were HCV/HIV co-infected, 40.8% were HCV monoinfected, and 7.2% were HCV and HIV- seronegatives. Elevated AST was associated with male gender and lower CD8(+) cell count in the HCV monoinfected patients, and with age and lower cholesterol in the HCV/HIV coinfected subjects. ALT elevation was associated with younger age, higher body mass index and male gender in the monoinfected patients, and with higher CD4(+) cell counts and lower cholesterol in the co-infected group. Male sex was strongly associated with elevated ALT and AST transaminase in the monoinfected but not in dual-infected subjects.These data suggest that the effect of gender on liver enzymes may be lost in patients with HIV infection. The overall differences observed between groups regarding liver enzyme elevations are of clinical relevance in the management of IDUs with chronic hepatitis C.
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