MORTALITY FROM LIVER DISEASE INCREASING IN HIV-POSITIVE PATIENTS
By Will Boggs
Reuters 8 February 2001
Westport, CT -- End-stage liver disease has become a
major cause of death among patients infected with HIV, according to a
report in the February 1st issue of Clinical Infectious Diseases.
Many HIV-seropositive patients are coinfected with hepatitis C virus
(HCV), the authors explain, and the course of HCV-related liver disease
from chronic active hepatitis to end-stage liver disease and death is
accelerated in these patients.
Dr Barbara McGovern, and colleagues, from New England Medical Center,
Boston, Mass, examined the causes of death among HIV-positive patients
who died at their institution, Lemuel Shattuck Hospital in Jamaica
Plain, Mass, during 1991 (group 1), 1996 (group 2), and 1998 to 1999
Most of the patients likely acquired HCV and/or HIV infection as a
result of injection drug use, the report indicates. Along with
antiretroviral therapy, most of the individuals received other
potentially hepatotoxic agents, the researchers note, and most patients
who underwent testing had antibodies to HCV and to hepatitis B virus
Only 11.5% of the deaths in group 1, during the years before highly
active antiretroviral therapy (HAART), resulted from complications of
end-stage liver disease, Dr McGovern and associates found. When HAART
was being introduced, during the time of the group 2 patients, the
mortality from end-stage liver disease rose only slightly, to 13.9% of
In group 3, however, well into the era of HAART, 50% of the deaths were
associated with end-stage liver disease, the authors report, with the
remainder distributed among sepsis, cytomegalovirus disease,
cryptococcal meningitis, and other causes.
"End-stage liver disease has become the leading cause of death of
HIV-seropositive patients at our institution," the authors conclude.
"This trend is occurring in the background of a dramatic decline in the
incidence of opportunistic infections and the rate of AIDS-related
mortality in the era of HAART."
"HIV providers need to evaluate HIV and HCV simultaneously," Dr McGovern
suggested in a comment to Reuters Health. "Just as they get a CD4 cell
count and HIV RNA on that first visit, they need to check hepatitis
serologies and HCV RNA, and vaccinate as needed and get a liver biopsy
in patients who are viremic."