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Conference
"Is there evidence for an increase in the death rate from liver-related disease in patients withHIV? : The EuroSIDA study" Dr. Jens Lundgren (biography) English - 2005-11-19 - 25 minutes
(13 slides)
Summary : Objectives: Increases in deaths from liver-related disease (LRD) among HIV-infected individuals have been reported, largely due to coinfection with hepatitis B (HBV) and/or C (HCV) viruses. The influence of combination antiretroviral therapy (cART) on LRD is controversial. The aim of this study was to determine changes over time in the death-rate from LRD and if longer exposure to cART was associated with an increased death-rate from LRD.
Results: Of 10,937 patients, 184 (1.7%) died from LRD during 52,236 person-years follow-up (PYFU). At recruitment, 587 patients were known to be coinfected with HBV (5.4%) and 1874 with HCV (17.1%). The death-rate from LRD declined from 6.9 per 1000 PYFU before 1995 (95% CI 3.9-9.9) to 2.6 at/after 2004 (95% CI 1.6–4.0). The decline was not statistically significant after adjustment for differences in baseline factors (exposure group, CD4 count, AIDS diagnosis, started cART; IRR 0.98; 95% CI 0.92– 1.04, p=0.49). Adjusting for current CD4 count and other factors, there was a 13% increase in the death-rate from LRD per year (95% CI 5–20%, p=0.0008). In patients who started cART, there was a 12% increase in the death-rate from LRD per additional year exposure to cART (95% CI 4–20%, p=0.022) after adjustment for current CD4 count and other factors.
Conclusion: Death-rates from LRD appear in patients with HIV seem to have declined across Europe. However, after adjustment for the current CD4 count, and therefore increases in CD4 counts in patients taking cART, there was evidence of a significant increase over time in death-rates from LRD. In patients with similar CD4 counts, longer exposure to cART was associated with an increased death-rate from LRD. This may be due to direct liver toxicity of antiretrovirals, progression of liver disease due to hepatitis B or C over time as patients survive longer, or some other factor.
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