Relationship of HCV Infection to Mortality In Families
Abstract & Commentary
By Dean L. Winslow, MD, FACP, Chief, Division of AIDS Medicine, Santa Clara Valley Medical Center; Clinical Professor of Medicine, Stanford University School of Medicine, Section Editor, HIV, is Associate Editor for Infectious Disease Alert.
Source: Hansen AB, et al Mortality in Siblings of Patients Coinfected with HIV and Hepatitis C Virus. J Infect Dis. 2007;195:230-235.
Synopsis: 437 siblings of HIV/HCV-coinfected patients, 1856 siblings of HIV-monoinfected patients, and 285,509 siblings of control subjects were studied. Mortality was significantly higher in siblings of HCV-coinfected patients than either siblings of HIV-monoinfected patients or siblings of controls.
This interesting study from Denmark used data from the comprehensive Danish Civil Registration System to examine mortality in siblings of HIV/HCV-coinfected patients, HIV-monoinfected patients, and controls. Mortality rates of siblings of HIV/HCV coinfected patients (3.4-7.3 deaths/1000 person-years) were strikingly increased at all decades of life from 20-49 years over mortality rates seen in siblings of HIV-monoinfected patients (1.4-1.9 deaths/1000 person-years) and siblings of control subjects (0.8-2.1 deaths/1000 person years).
It is estimated that 30% of HIV-infected patients in Western countries are coinfected with hepatitis C virus. Most cohort studies have shown increased liver-related mortality in coinfected patients vs HIV-monoinfected patients. Data are conflicting on the effect of HCV coinfection on non-liver related mortality in HIV patients. This large cohort study conclusively demonstrates strikingly higher mortality in siblings of patients co-infected with HCV and HIV over siblings of either HIV-monoinfected patients or siblings of normal control subjects. A key to the possible explanation is found on examination of the baseline characteristics table of the paper. Not surprisingly 67% of the coinfected patients acquired their HIV infection by injection drug use (IDU). While data on high-risk behavior were not available on the siblings, it seems likely that the siblings of these HIV/HCV-coinfected patients may have also suffered from addiction or made other high-risk lifestyle choices that served to increase their mortality as well as that of their coinfected siblings.
I found the implications of this article to be profoundly disturbing, but not particularly surprising on further reflection. Practicing where I do now at our county hospital and serving as the medical director of our HIV clinic, I see daily the end results of the tragic lives of so many of our patients. When one talks with so many of our HIV/HCV-coinfected patients it is clear that many of them were severely abused (physically, sexually, verbally, and emotionally) during their childhoods. Infection with these viruses was a predictable consequence as they tried to soothe the pain in their souls with drugs or risky sex. In view of this, it is not surprising that that the HIV-negative siblings of these patients lead the same sorts of tragic lives.
In reality, it is often too late to "save" many of our patients. However, it is not too late to save the next generation and to intervene in meaningful ways to break the familial cycle of abuse, neglect and despair. As American citizens and people of conscious we should do all we can to promote public support of early childhood enrichment programs, child care, emotional support for parents, and, of course, drug and alcohol rehabilitation. In addition to voting, we should make our priorities known to our elected representatives. We should also be generous in our charitable giving.