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Hepatitis C coinfection increases the risk of fulminant hepatic failure in patients with HIV in the HAART era.

Kramer JR, Giordano TP, Souchek J, El-Serag HB. Hepatitis C coinfection increases the risk of fulminant hepatic failure in patients with HIV in the HAART era. Journal of Hepatology. 2005 Mar 1; 42(3):309-14.

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BACKGROUND/AIMS: It is uncertain if patients coinfected with hepatitis C and HIV are more likely to suffer fulminant hepatic failure (FHF) when compared to patients with HIV-only. METHODS: We conducted a retrospective cohort study using national administrative databases from the Department of Veterans Affairs in patients hospitalized for the first time with HIV and/or hepatitis C between 10/1991 and 9/2000. Fulminant hepatic failure was defined as occurring after the index hospitalization through 9/2001 in the absence of pre-existing liver disease. We calculated incidence rates, Kaplan Meier cumulative incidence curves, and Cox proportional hazards ratios while adjusting for demographics and other potential confounders. RESULTS: We identified 11,678 patients with HIV-only and 4761 patients with coinfection. There were 92 cases of fulminant hepatic failure yielding an incidence rate of 1.1/1000 person-years and 2.5/1000 person-years in the HIV-only and coinfected groups. The cumulative incidence of fulminant hepatic failure in the coinfected group was higher than in the HIV-only group (P < 0.0001). The risk of fulminant hepatic failure in patients with coinfection compared to HIV-only during the HAART era was several folds higher than that during the pre-HAART era. CONCLUSIONS: HAART and hepatitis C coinfection appeared to act synergistically in HIV-infected patients to increase the risk of fulminant hepatic failure, a rare but often fatal disease.

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