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    Avaliação da frequência de descompensação de cirrose hepática e óbito por doença hepática terminal em pacientes coinfectados pelo HIV/HCV e em pacientes vivendo exclusivamente com HCV
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Santos, Damiana Montes [UNIFESP]; Ferreira, Paulo Roberto Abrao [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: People living with HIV have higher mortality rates when compared to the general population. Among the main non-AIDS-related causes of death in this population are liver diseases, which lead to cirrhotic liver failure or hepatocellular carcinoma. HIV / HCV coinfection determines a worse natural history for each virus. People living with HIV have higher levels of HCV RNA, more frequent viral persistence in primary HCV infection, faster progression to cirrhosis, higher risk of HCC, and higher mortality. For these reasons, it is important to identify factors associated with clinical outcomes in HIV / HCV co-infected compared with HCV monoinfected. In addition, it is necessary to define more appropriate behaviors for each of these populations. Objectives: To determine the mortality rate among coinfected HCV / HIV and HCV monoinfected cirrhotic patients. To determine the rate of hepatic decompensation and its characteristics by comparing these two cohorts. Methods: A retrospective, observational, non-probabilistic longitudinal study was conducted from a case series involving two centers with all patients with cirrhosis living with HIV / HCV or exclusively with HCV, until october 2012. Results: 138 patients were analyzed, 84 of them living with HCV and 54 with HIV / HCV. Coinfected patients were, on average, younger at the time of diagnosis of cirrhosis (HCV - 55 years, SD 11; HCV / HIV - 43 years, SD 8; p <0.0001). Most patients (52.1%) received treatment for HCV (peginterferon or standard interferonxviii with ribavirin) with SVR in only 23.6% of patients, mostly monoinfected (37.2%, p <0.002). SVR occurred in 16 (37.2%) monoinfected and 1 (3.2%) coinfected and this difference was statistically significant (p <0.002). We observed that the CPT score showed a higher predominance of Child A in both cohorts (HCV 71.4%, 60/84; HCV / HIV 46.3%, 25/54; p <0.005) and more cases of Child B and C among co-infected (HCV 20.2%, 17/84; HCV / HIV 44.4%, 24/54; p <0.005). Decompensations occurred in 28.3% of the patients and most of them in co-infected patients (HCV 22.6%, 19/84; HCV / HIV 38.9%, 21/54), but this difference was not significant (p <0.082). Regarding the hepatic decompensations observed in this study (ascites, esophageal variceal bleeding and encephalopathy), the predominant event was ascites (48.3%), followed by bleeding from esophageal varices (31%) and hepatic encephalopathy (20.7%). Ascites (HCV 13.1%, 11/84; HCV / HIV 31.5%, 17/54) and hepatic encephalopathy (HCV 3.6%, 3/84; HCV / HIV 16.7%, 9/54) tend to be more frequent in co-infected patients (p <0.009 and p <0.008, respectively). Regarding bleeding from esophageal varices (HCV 10.7%, 9/84; HCV / HIV 16.6%, 9/54), there were no differences between the groups (p <0.310). Most deaths occurred in co-infected patients (HCV 8.3%, 7/84; HCV / HIV 18.5%, 10/54; p <0.007). Of the 17 deaths that occurred, only two were not related to liver disease (11.8% among deaths): one death in monoinfected due to subarcanoid hemorrhage and one death in coinfected because of unknown cause. The number of weeks from diagnosis of liver cirrhosis to death was higher for co-infected patients (HCV-average / median 121.2 / 116, SD 100.6, 4 to 575; HCV / HIV-average 209.3, SD 213, 4, 1 to 974; p <0.001), contrary to what was observed for the time from diagnosis until the first hepatic decompensation (HCV- mean 70, DP 112,7, 0 a 465; HIV/HCV – mean 37,7, DP 6,1, a 270; p=0,306). Conclusions: Mortality for coinfected patients was more than twice as high as for monoinfected patients. In our study, co-infected patients were diagnosed with liver cirrhosis younger than monoinfected patients, but had worse CPT scores at the time of diagnosis of cirrhosis.