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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 p atients with HIV- only. Methods: We conducted a retrospective cohort study usin g national administrative databases from the Department of Veterans Affairs in p atients hospitalized for the first time with HIV and/or hepatitis C between 10/1 991 and 9/2000. Fulminant hepatic failure was defined as occurring after the ind ex hospitalization through 9/2001 in the absence of pre- existing liver disease . We calculated incidence rates, Kaplan Meier cumulative incidence curves, and C ox proportional hazards ratios while adjusting for demographics and other potent ial confounders. Results: We identified 11,678 patients with HIV- only and 4761 patients with coinfection. There were 92 cases of fulminant hepatic failure yie lding an incidence rate of 1.1/1000 person- years and 2.5/1000 person- years i n the HIV- only and coinfected groups. The cumulative incidence of fulminant he patic 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 co mpared to HIV- only during the HAART era was several folds higher than that dur ing the pre- HAART era. Conclusions: HAART and hepatitis C coinfection appeared to act synergistically in HIV- infected patients to increase the risk of fulmi nant hepatic failure, a rare but often fatal disease.
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 p atients with HIV-only. Methods: We conducted a retrospective cohort study usin g national administrative databases from the Department of Veterans Affairs in p atients hospitalized for the first time with HIV and / or hepatitis C between 10/1 991 and 9/2000. Fulminant hepatic failure was defined as occurring after the ind ex hospitalization through 9/2001 in the absence of Pre-existing liver disease. We calculated incidence rates, Kaplan Meier cumulative incidence curves, and C0sponsibility hazards ratios while adjusting for demographics and other potent ial confounders. Results: We identified incidences of 6,668 with HIV-only and 4761 patients with coinfection. There were 92 cases of fulminant hepatic failure yie lding 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 he patic 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 co mpared to HIV-only during the HAART era was several folds higher than that dur ing the pre- HAART era. Conclusions: HAART and hepatitis C coinfection to act synergistically in HIV-infected patients to increase the risk of fulmi nant hepatic failure, a rare but often fatal disease.