High Rate of Liver-Related Mortality among HIV Positive Persons in France  As
effective antiretroviral therapy has dramatically reduced the rate of death due
to opportunistic illnesses and allowed people
with HIV/AIDS to live longer, liver-related deaths have come to account for a larger proportion of mortality
in this population. Several past studies suggest that HIV
positive patients coinfected with hepatitis C virus (HCV) are at higher risk
of advanced
liver disease and liver-related death.
As
reported in the March 2007 Journal of Viral Hepatitis, French researchers
conducted a study to determine mortality due to end-stage
liver disease (ESLD) in a nationwide population of HIV-infected patients 7
years following the introduction of HAART. All departments of internal medicine
and infectious diseases participating in the GERMIVIC Study Group prospectively
recorded all deaths among HIV positive patients during 2003; 59 departments with
a total of 20,940 patients participated. Results were compared with those of previous surveys sing similar
methodology in 1995, 1997, and 2001.
Results·
Among 215 deaths reported during 2003:
—
101 (46.9%) were related to AIDS;
—
27 (12.6%) were related to ESLD;
— 87 (40.5%) were due
to other causes.
·
Mortality due to ESLD represented 23.7% of all non-AIDS-related
deaths.
·
92.6%
of patients who died from ESLD had chronic hepatitis C.
·
Liver
disease was exacerbated by moderate (30-60 g) alcohol consumption in 43.5%, and
heavy (> 60 g) alcohol consumption in 26.0%.
·
In this population, the proportion of all deaths among HIV positive
people that were due to ESLD were:
—
1.5% in 1995;
—
6.6% in 1997;
—
14.3% in 2001;
—
12.6% in 2003.
The
prevalence of hepatocellular
carcinoma as a cause of death remained high in 2003, but stable when comared with 2001 (25.0% vs 14.8%). Treatment of
hepatitis C in patients who died from ESLD was more frequent in 2003 (44.4%) than
in 2001 (26.3%).
Conclusion In
conclusion, the authors wrote, “Seven years after the introduction of HAART, ESLD
associated with HCV infections is a leading cause of mortality in HIV-infected
patients, which did not increase between the years 2001 and 2003.”
“These
findings emphasize the importance of developing effective strategies for the prevention
and treatment of chronic HCV infection in HIV-HCV coinfected patients, the reduction
of alcohol intake and the improvement of access to care,” they added.
These
data show that while the proportion of deaths due to liver disease among HIV positive
people rose after the introduction of HAART, the increase appears to have leveled
off in recent years, which may be related to more widespread hepatitis C treatment.04/27/07 Reference
E
Rosenthal, G Pialoux, N Bernard, and others. Liver-related mortality in human-immunodeficiency-virus-infected
patients between 1995 and 2003 in the French GERMIVIC Joint Study Group Network
(MORTAVIC 2003 Study). Journal of Viral Hepatitis 14(3): 183-188. March
2007. |
