Background:  The natural history of initially compensated cirrhosis due to hepatitis B (HBV) or hepatitis C (HCV) virus in patients co-infected with HIV is only partially defined. We have investigated the hierarchy of complications in compensated viral cirrhosis over a long follow up period.

Methods:  We reviewed retrospectively the medical record of a single-center cohort of Italian HIV patients. Among them we selected those with initially compensated cirrhosis of viral etiology (HCV or HBV). They were followed up at 3-month intervals with laboratory tests to identify major complications (ascites, gastrointestinal bleeding, portal-systemic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome) and mortality rate due to liver related causes.

Results:  Between 1999 and 2004, 409 HIV patients underwent a follow-up of at least 6 months. We identified 61 patients (15%) with initially compensated cirrhosis (7 HBV⁺, 51 HCV⁺, and 3 HBV- and HCV-co-infected). During the follow-up, the number of cases of decompensation increased from 6 in 1999 to 57 in 2003 and 44 in 2004 (see graph). Overall, the most frequent complication was ascites, followed by encephalopathy, jaundice, hepatorenal syndrome, hepatocellular carcinoma, and gastrointestinal bleeding. Death from liver disease occurred in 16 of 61 (26%) cases.

Conclusions:  These results indicate significant morbidity and mortality during the first 5 years after diagnosis of compensated cirrhosis in co-infected patients, and identify ascites as the most frequent complication. The incidence of HCV co-infection seems to be increasing while gastrointestinal bleeding is less frequent.