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August 30, 2006
Liver Disease Is Leading Cause of Death (Reuters Health)
August 30, 2006 (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.
