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. 2007 Aug 15;2(8):e738.
doi: 10.1371/journal.pone.0000738.

Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus

Ann-Brit Eg Hansen  1 , Nicolai Lohse, Jan Gerstoft, Gitte Kronborg, Alex Laursen, Court Pedersen, Henrik Toft Sørensen, Niels Obel
Affiliations

Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus

Ann-Brit Eg Hansen et al. PLoS One. .

Abstract

Background: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality.

Methodology and principal findings: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality rates (EMR) for siblings of HIV/HCV-co-infected individuals (n = 436) and siblings of HIV mono-infected individuals (n = 1837) compared with siblings of population controls (n = 281,221). Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56-4.50) per 1,000 person-years, compared with siblings of matched population controls. Substance abuse-related deaths contributed most to the elevated mortality among siblings [EMR = 2.25 (1.09-3.40)] followed by unnatural deaths [EMR = 0.67 (-0.05-1.39)]. No siblings of HIV/HCV co-infected patients had a liver-related diagnosis as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16-1.05) compared with siblings of controls. This modest excess mortality was due to deaths from an unknown cause [EMR = 0.28 (0.07-0.48)], deaths from substance abuse [EMR = 0.19 (-0.04-0.43)], and unnatural deaths [EMR = 0.18 (-0.06-0.42)].

Conclusions: HCV co-infection among HIV-infected patients was a strong marker for family-related mortality due to substance abuse and other unnatural causes. To reduce morbidity and mortality in HIV/HCV-co-infected patients, the advances in antiviral treatment of HCV should be accompanied by continued focus on interventions targeted at substance abuse-related risk factors.

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Conflict of interest statement

Competing Interests: Niels Obel has received research funding from Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Abbott, Boehringer-Ingelheim, Janssen-Cilag, and Swedish Orphan. Jan Gerstoft has received research funding from Abbott, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, Pharmacia, GlaxoSmithKline, Swedish Orphan, and Boehringer-Ingelheim. Ann-Brit Eg Hansen, Nicolai Lohse, Alex Laursen, Court Pedersen, and Henrik Toft Sørensen have no conflicts of interest.

Figures

Figure 1
Figure 1. Summary of the study design.
CRS, the Danish Civil Registration System; HCV, Hepatitis C virus. * Number of siblings in
See this image and copyright information in PMC

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