Clinical outcomes of HIV-HCV co-infection in a large cohort of hemophiliac patients

Abstract Objective. To determine the disease progression of HIV-HCV co-infected hemophiliacs in a large cohort of patients ( n =288) cared for at a single medical institution. Patients and methods. Annual mortality rates for AIDS- and liver-related death were calculated and Kaplan–Meier survival plots were drawn to determine the progression to AIDS and death. Results. Between January 1985 and December 2002, 179 (62.2%) and 195 (67.7%) of these patients had developed AIDS or died, respectively. Overall, AIDS accounted for 128 deaths, which almost entirely (93.7%) occurred prior to the introduction of highly active antiretroviral therapy (HAART) at the end of 1995. A total of 29 patients died of liver failure, most of them (69%) during the years 1991–1996. Since 1997, only five cases of fatal liver failure were reported. Non-HIV-HCV related reasons were responsible for 38 deaths and occurred predominantly (47%) in the years 1997–2002. Starting November 1995, 72 patients were treated with HAART. However, by December 2002, only 52.5% and 83% of all HAART-treated patients had a stable viremia ( + T-cell count (>200/μl), respectively. Conclusion. These data indicate that liver-related mortality peaked in the years 1991–1996, but subsequently tended to decline. Moreover, despite widespread treatment of patients with HAART, a significant proportion of individuals had an unsatisfactory immunological and virological status at the end of 2002.