Liver-related
Deaths among People with HIV May Be Decreasing Due to Declining Hepatitis C Prevalence
By
Liz Highleyman Since
the advent of effective combination
antiretroviral therapy, liver disease has become a major cause of death for
people with HIV, especially those coinfected
with hepatitis B or C virus
(HBV and HCV, respectively). HIV
and HCV are transmitted by similar routes, and a significant proportion of HIV
positive people are coinfected with HCV (10%-90% in different subgroups). Among
the HIV negative population, however, the rate of new HCV infections has fallen
dramatically since the virus was identified in 1989 and prevention measures like
screening of donated blood and needle exchange programs for injection drug users
have been implemented. Now,
evidence presented at the 16th Conference on Retroviruses
and Opportunistic Infections (CROI 2009) this month in Montreal suggests that
the overall decline in HCV prevalence may be starting to reduce liver-related
mortality among some HIV positive groups in the U.S.
David Rimland from
the Atlanta Veterans Affairs Medical Center (VAMC) and colleagues evaluated the
changing prevalence of HCV infection in their HIV positive cohort and the changing
age of HIV-HCV coinfected patients. As background, they noted that they have seen
a decreasing rate of liver-related mortality since 1993.
The HIV Atlanta
Veterans Affairs Cohort Study (HAVACS) has prospectively collected demographic,
laboratory, clinical, and mortality data on 3321 HIV positive patients followed
at the Atlanta VAMC since 1982.
In this analysis, causes of death were
determined from electronic medical records or death certificates. Data were divided
into 3 periods: pre-HAART (1982-1995), early HAART (1996-2000), and recent HAART
(2001-2008).
Results
1404 patients in the cohort died between 1982 and 2008.
Of these deaths, 77 (5.5%) were liver-related and 33 (2.4%) were HCV-related.
When calculated as a percentage of all deaths, liver-related deaths accounted
for 3.9% in the pre-HAART period, rising to 8.0% in the early HAART period, but
falling to 5.6% in the late HAART period.
HCV-related deaths accounted for 0.7% in the pre-HAART period, 4.8% in the early
HAART period, and 3.2% in the late HAART period.
The rate of liver-related deaths decreased in the most recent period to 33 per
100 person-years (PY) of follow-up, from 84 per 100 PY in the early HAART period.
Over the study period, the prevalence of HCV coinfection in the cohort decreased
from a high of 38.6% in 1996 to 19.0% in 2008.
The median age of HIV-HCV coinfected patients increased from 35 years in 1990
to 54 years in 2008, reflecting an aging subgroup without a large influx of newly
HCV-infected individuals.
Based
on these findings, the investigators concluded, "In this cohort, liver-related
mortality remains a minor cause of death when calculated either as a percentage
of all deaths or as an annual rate."
"The actual rate of liver-related
deaths is decreasing in the recent HAART era and is associated with a decreasing
prevalence of HCV coinfection," they added. "The increasing median age
of coinfected patients suggests that there may be an effect of competing causes
of mortality."
2/24/09 Reference
D
Rimland, J Guest, and A Moanna. Decreasing Liver-related Mortality Associated
with a Decreasing Prevalence of HCV Co-infection: Data from the HIV Atlanta Veterans'
Affairs Cohort Study. 16th Conference on Retroviruses and Opportunistic Infections
(CROI 2009). Montreal, Canada. February 8-11, 2009. Abstract 805. |
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