Epidemiology

Liver disease leading cause of non-AIDS deaths in HIV patients in developed countries

Last Updated: 2006-08-24 15:21:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In the United States, Europe and Australia, the leading cause of non-AIDS mortality is liver-related, a European consortium reports in the Archives of Internal Medicine.

In the August 14/28 issue, findings of the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group, led by Dr. Rainer Weber of University Hospital in Zurich, are presented for 23,441 HIV infected persons followed for 3.5 years, or a total of 76,893 person-years.

There were 1246 (5.3%) deaths from all causes. Of these deaths, 14.5% were liver-related. Among patients who died of liver-related causes, 66.1% had hepatitis C (HCV) infection, 16.1% had hepatitis B (HBV) infection and 7.1% were co-infected with both viruses.

Risk factors for liver-related deaths in HIV in order of degree of risk were lower CD4 cell counts, HCV infection, active HBV infection, intravenous drug use and older age.

The relative risk of death for those with a CD4 count below 50 cells per microliter compared with those with CD4 counts higher than 500 cells per microliter was 16.1. Relative risk of death was 6.7 with HCV RNA levels that were lowest compared to highest relative risk was 3.7 with active HBV infection, and risk of liver-related deaths were doubled with intravenous drug use.

The D:A:D Study Group writes that "the strong association between immunodeficiency and an elevated risk of liver-related deaths underlines the importance of HIV strategies that prevent immunodeficiency." The investigators conclude that studies are needed to determine the value of starting combination antiretroviral therapy in patients at risk of liver-related death.

Arch Intern Med 2006;166:1632-1641.