3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

IMPACT OF LAMIVUDINE (3TC) ON THE RISK OF LIVER RELATED DEATH (LRD) IN 2,041 HBSAG AND HIV-POSITIVE INDIVIDUALS. RESULTS OF AN INTERCOHORT ANALYSIS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe1.1C06

Puoti M.¹, Cozzi-Lepri A.², Paraninfo G.³, Lundgren J.⁴, Rickenbach M.⁵, Suarez-Lozano I.⁶, Winnock M.⁷, Gervais A.⁸, Gill J.⁹, Rockstroh J.¹⁰, Mussini C.¹¹, Castagna A.¹², De Luca A.¹³, d'Arminio Monforte A.^14
1ICONA and Master cohorts, Brescia, Italy, ²ICONA cohort, London, United Kingdom, ³Master cohort, Brescia, Italy, ⁴EuroSIDA cohort, Copenhagen, Denmark, ⁵Swiss HIV cohort, Lausanne, Switzerland, ⁶Spanish VACH cohort, Huelva, Spain, ⁷Aquitaine cohort, Bordeaux, France, ⁸Aproco cohort, Paris, France, ⁹South Alberta cohort, Calgary, Canada, ¹⁰Koln-Bonn cohort, Bonn, Germany, ¹¹Modena cohort, Modena, Italy, ¹²HSR cohort, Milan, Italy, ¹³UCSC Rome cohort, Rome, Italy, ¹⁴ICONA and IMIT cohorts, Milan, Italy

INTRODUCTION: The impact of antiretroviral therapy (ART) with 3TC on the risk of LRD has not been extensively studied.

METHODS: We performed an analysis involving HIV/HBV co-infected pts of 13 cohorts who initiated HAART. End-point was LRD, ie. death with concomitant decompensated liver disease (DLD) or hepatocellular carcinoma (HCC) in the absence of other causes, by three experts examining the causes of death. Incidence rates of LRD after HAART initiation were expressed as #events per 100 person-years (py). A Poisson regression model adjusted for cohort, gender, mode of HIV transmission, CD4 at HAART initiation, liver disease pre-HAART, duration of 3TC before HAART, and HCV was used to assess the association between use of 3TC and risk of LRD.

RESULTS: We analysed 2,041 pts, 758 (37.1%) IDUs. Before HAART, 1,075 pts (52.7%) had received ART, 598 (29.3%) with 3TC. Follow up after starting HAART was 7,648 py (5,569 spent on 3TC-containing regimens) with a median of 48 months (range: 2-91). 217 pts died; 57 deaths were LRD for a rate of 7.5 per 1,000 py (95% CI: 5.6-9.7). Of 38 pts with LRD and information on liver morbidity occurring prior to death (these data were not collected in 2 cohorts), 21 (55.3%) had experienced DLD or HCC. In a model including all 57 deaths, the RR of LRD per year of 3TC use was 0.73 (95% CI: 0.59-0.90, p=0.004). As controls, we assessed the rates associated with the use of d4T (RR=1.02, 95%CI: 0.85-1.22, p=0.85), ZDV (RR=0.83, 0.67-1.03, p=0.10), ddI (1.01, 0.76-1.36, p=0.90) and ddC (RR=0.34 0.05-2.40, p=0.28).

CONCLUSIONS: The use of 3TC was associated with a reduced risk of LRD over a median of 4 yrs. Data need to be re-assessed after longer follow-up to verify if this effect is retained in spite of the development of YMDD mutations.

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050724
Clinical | TuPe1.1C06 | Massimo Puoti
Hepatitis viruses

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