http://www.medscape.com/viewarticle/543688
Liver Disease Leading Cause of Non-AIDS Deaths in HIV Patients in Developed
Countries

NEW YORK (Reuters Health) Aug 24 - 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


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