Background:  Highly active antiretroviral therapy (HAART) has dramatically increased life expectancy for persons diagnosed with AIDS. Consequently, as co-infection with hepatitis C (HCV) and HIV is very common, chronic HCV is emerging as an important cause of mortality within the AIDS population. This study quantifies the contribution of HCV to mortality among people living with AIDS (PLWA) in New York City, a major epicenter of the HIV/AIDS epidemic in the United States.

Methods:  The NYC HIV/AIDS Registry and the NYC Vital Statistics Registry were used to identify PLWA who died in NYC during 1993 to 1999. HCV-related deaths were determined using primary and multiple cause-of-death ICD-9 and ICD-10 codes. Using chi-square analyses, demographic characteristics were evaluated for PLWA who died of HCV-related deaths vs all other causes of death. For each year, a mortality proportion was calculated comparing HCV-related deaths to all other causes of death among PLWA. Additionally, annual HCV-related mortality rates, rate ratios and 95% confidence intervals were calculated to assess whether HCV-related mortality rates among PLWA were higher than those in the general NYC population.

Results:  The proportion of deaths attributed to hepatitis C among PLWA increased from approximately 0.3% in 1993 to nearly 4% in 1999. In the same population, HCV-related mortality rates also increased significantly from 1993 to 1999 (from 25.9 to 136.7 per 100,000). In 1999, the HCV-related mortality rate for PLWA was significantly higher than the HCV-related mortality rate in the general NYC population (RR:  22.1; 95% CI:  (18.3, 26.7)). Among PLWA, Hispanics had a significantly higher HCV-related mortality rate in 1999 than both African Americans and Caucasians (RR:  1.7, 95% CI:  (1.3, 2.2)). Additionally, injection drug users (IDU) were significantly more likely to die of HCV-related causes than from all other causes of death (79.2% vs 50.2%, respectively, chi-squared p = <0.0001).

Conclusions:  Hepatitis C-related mortality rates in the NYC PLWA population have increased significantly since the early 1990s. Among PLWA, Hispanics and IDU are most affected by HCV-related mortality. Moreover, PLWA have a much higher HCV-related mortality rate than the general NYC population. Thus, HCV/HIV prevention, diagnostic, and treatment services should be especially concentrated among and tailored to persons affected with or at highest risk for both infections.

Keywords: Hepatitis C; mortality; New York City