Mortality Due to Hepatitis C Virus–Related Cirrhosis in Patients Infected with HIV Type 1: A Role for Alcohol

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Abstract
SIR—Two recent reports in Clinical Infectious Diseases [1, 2] have described conflicting results and come to different conclusions regarding mortality due to end-stage liver disease in patients infected with HIV type 1 (HIV-1). Both studies were retrospective and evaluated deaths due to hepatitis C virus (HCV)–related cirrhosis or hepatocellular carcinoma [2] or to liver cirrhosis (HCV related in almost all cases) [1]. Although the national, multicenter French study failed to show an increase in HCV-related mortality rates from 1995 to 1997 [2], the small study performed at a single hospital in Massachusetts highlighted HCV-related cirrhosis as the leading cause of death among HIV-1–infected individuals in 1998–1999 [1]. Our findings parallel those of the French authors: we observed no increase in the absolute number of deaths due to cirrhosis in our HIV-1–infected patient population in 1997–2000, compared with 1991–1996, but only observed an increase in the percentage, which was the result of a dramatic decrease in the AIDS-related mortality rate.

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