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Background:  HIV infection accelerates the emergence of decompensated hepatitis C virus (HCV)-related cirrhosis. However, the influence of HIV-co-infection on the survival of patients with HCV-related end stage liver disease is unknown. Since HIV infection is no longer considered an absolute contraindication for liver transplantation, it has become a priority to ascertain the effect of HCV-related end stage liver disease in HIV infection. The objective of this study was to compare the survival of HIV-infected and HIV-uninfected patients with decompensated cirrhosis due to HCV.

Methods:  In a retrospective cohort study, the survival of 1037 HCV-mono-infected and 180 HCV/HIV-co-infected patients with liver cirrhosis after the first hepatic decompensation was analyzed.

Results:  During the follow-up, 386 (37%) HCV-mono-infected patients and 100 (56%) HCV/HIV-co-infected subjects died. The median survival time of HIV-infected and HIV-uninfected patients was 16 and 48 months (p < 0.001), respectively. The relative risk (95% CI) of death for HIV-infected patients was 1.9 (1.3 to 2.8). Other independent predictors of survival were age > 63 years (1.8; 1.4 to 2.3), Child Pugh stage B vs A (1.7; 1.3 to 2.3), C vs A (3.5; 2.5 to 4.9), hepatitis D virus infection (2.2; 1.1 to 4.4) and the type of the first hepatic decompensation, with a poorer prognosis associated with hepatic encephalopathy in relation to portal hypertensive gastrointestinal bleeding (1.9; 1.3 to 2.9).

Conclusions:  HIV co-infection considerably reduces the survival of patients with HCV-related liver cirrhosis after the first hepatic decompensation. This effect is independent of other markers of poor prognosis. This fact must be taken into account to establish the adequate timing to consider HIV-co-infected patients with HCV-related end-stage liver disease as candidates for liver transplantation.

Keywords: hepatitis C virus; cirrhosis; liver transplantation