Objective: In response to reports of increasing HCV-related mortality in subjects with HIV, investigators examined the cause of death in HIV-infected subjects at their institution.

Methods: Investigators retrospectively reviewed the charts of all HIV-infected subjects who died at Lemuel Shattuck Hospital in Jamaica Plain, Massachusetts in 1991, 1996, and 1998-1999 and determined which subjects died with underlying diagnosis of infection or AIDS. Subjects who died during the 3 study periods were examined for cause, demographic characteristics, CD4 cell counts, plasma HIV RNA levels, markers of HCV and HBV infection, history of substance abuse, and information regarding use of HAART.

Results: Eighty-four subjects with HIV infection died during the 3 study periods (26 in 1991, 36 in 1996, and 22 in 1998-1999). The predominant risk factor for HIV, HCV, and HBV in most subjects was a history of IVDU. It appeared that subjects in the first 2 cohorts (prior to widespread use of HAART) had advanced HIV infection, while 11 of 22 of those who died in 1998-1999 died of ESLD; 6 of these 11 subjects had CD4 cell counts >200 cells/mm³ or nondetectable HIV viral load within 1 year of death and 90% tested positive for HCV antibodies. Of the subjects who died in 1998-1999, 31.8% had a recent history of antiretroviral therapy discontinuation due to development of hepatotoxicity, in contrast to 0 who died in 1991 and 2 who died in 1996. Most subjects in all groups were coinfected with HIV and HCV (1991 group, 75%; 1996 group, 57.7%; and 1998-1999 group, 93.8%).

Conclusion: The impact of HCV infection on mortality in subjects coinfected with HIV and HCV mandates rigorous adherence to screening recommendations and emphasizes the need for effective therapies.