Cancer and hepatitis is an emerging cause of death among people infected with HIV

Besides AIDS, the causes of death among people infected with HIV most common in 2000 were viral hepatitis, non-AIDS defining cancers not related to hepatitis and cardiovascular damage, shows a French study published in the Weekly Epidemiological Bulletin National Institute of Health Surveillance (VS).
A brief overview
Since 1996, the use of highly active antiretroviral treatment, AIDS mortality has fallen sharply. Concerns for the management of HIV infection related to this comorbidities including hepatitis C and treatment failures, explain Lewden Charlotte, Inserm U593 in Bordeaux, and colleagues.

In their survey "Mortality in 2000," they sought to describe the distribution of causes of deaths in 2000 in France in adults infected with HIV and the characteristics of the deceased. The 185 services have participated have been in contact with infected patients 64,000, including 924 died, half before 41 years.

A third had not reached AIDS and another third had a higher rate of lymphocytes 200/mm ³, say the authors. In one third of cases was reported socio-economic insecurity.

The initial cause of death was AIDS in 47% of cases, followed by non-AIDS defining cancers not associated with hepatitis (11%), hepatitis C (9%), cardiovascular disorders (7%), infections bacterial (6%) and suicide (4%).

Non-Hodgkin's malignant lymphoma and cytomegalovirus infection were the two diseases most frequently involved in patients who died of AIDS. When the diagnosis of HIV infection was less than six months, the most frequent pathology was pneumocystis carinii pneumonia.

Cancers called "AIDS defining" were also non-Hodgkin's lymphoma, Kaposi's sarcoma and cancers of the cervix. Cancers "no AIDS defining" were mainly respiratory tract tumors, hepatocellular carcinoma, Hodgkin's disease, digestive cancers, other solid and hematologic cancers. Among hepatocellular carcinoma, half were due to HCV, and a little less than a third HBV.

Among the cardiovascular with the data mentioned ischemic coronary artery disease and strokes. Pneumococcal infections and pulmonary infections without specific etiology were bacterial infections most frequently found as the underlying cause of death in patients infected with HIV.

According to the study, patients who died of AIDS were less likely than those addicts who died of other causes (16% against 39%). 18% of them, the infection was less than 6 months (vs. 5% for others). The infection in this case was mostly heterosexually. Patients who died of hepatitis C were more frequent heavy drinkers (61% against 25%) and tobacco (78% against 50%). A quarter came from abroad.

The diagnosis dated less than 6 months in 1 case out of 5
These data allow the authors to estimate the number of deaths in 2000 among people infected with HIV in France, which reach 1,397, and the number of deaths among people with AIDS, 9974, a value higher than that given by monitoring system of notifiable diseases.

This study shows that the diagnosis of HIV infection was less than 6 months in five cases. It shows that people with a risk of heterosexual transmission and those born abroad are those that improved screening strategies is a priority, say the authors.

These further argue for expanding access to highly active internationally treatment, "an additional condition to improve the situation."

They also encourage "to intensify prevention efforts vis-à-vis risk factors such as smoking and alcohol consumption and improve strategies for early diagnosis and treatment of viral hepatitis and cancers," the pathologies frequently implicated in the deaths of HIV-positive patients.