Clinical

European HIV study finds rise in liver-related deaths

Last Updated: 2006-01-02 13:00:13 -0400 (Reuters Health)

By Anne Harding

NEW YORK (Reuters Health) - Deaths from liver-related disease (LRD) among patients with HIV and similar CD4 cell counts have increased over time, but the reasons behind the rise remain unclear, according to a new report.

"Hopeful this study will stimulate additional reports so we can start to get a picture together on what's actually going on," Dr. Jens D. Lundgren of the Copenhagen HIV Program in Hvidovre, Denmark told Reuters Health.

Possibilities include exposure to combination antiretroviral therapy (cART), the fact that patients are living longer with hepatitis B or hepatitis C infections, or even increased use of alcohol, he noted.

Dr. Lundgren and his colleagues in the EuroSIDA Study Group conducted the current study to investigate reports of increases in liver-related disease among patients with HIV, and to determine if length of exposure to cART had any effect on liver-related disease.

The researchers looked at 10,937 patients participating in EuroSIDA, 1.7% of whom died from liver-related disease during follow-up. Their initial analysis found that liver-related disease declined from 6.9 per 1,000 person-years of follow-up (PYFU) before 1995 to 2.6 per 1,000 PYFU at or after 2004.

The rate of liver-related disease was strongly associated with CD4 cell count, with patients with current counts below 50 cells per microliter having a liver-related disease death rate of 14.1 per 1,000 PYFU, compared to 7.0 per 1,000 PYFU for patients with counts above 50.

Once the data was adjusted for CD4 cell count, the researchers found death rates from liver-related disease actually increased by 13% per year. Among patients on cART, deaths from liver-related causes increased by 12% for every year of exposure to the drugs. Patients positive for HbsAg had nearly triple the risk of death from liver-related disease, while anti-HCV increased liver-related disease risk more than five-fold.

Based on the findings, Dr. Lundgren said, "we need to understand that liver-related death is a problem in HIV and we need to target the modifiable risk factors that influence the risk of liver related death. They include ongoing hepatitis B infection, ongoing hepatitis C infection, and alcohol."

Consulting with patients on alcohol use is particularly important for HIV patients with hepatitis C infection, he added. "We know that, for example, in hepatitis C, if you drink, the alcohol actually works synergistically with the infection to accelerate fibrosis of the liver."

He and his colleagues conclude: "cART continues to have a major benefit for reducing the risk of AIDS or HIV-related deaths, and in reducing liver-related deaths, and the increased death rate from liver-related disease with longer exposure to combination therapy should be balanced against its many benefits."

AIDS 2005;19:2117-2125.