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

IMPACT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART). ON LIVER RELATED MORTALITY

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe2.3C27

Puoti M.¹, Prestini K.¹, Torti C.¹, Patroni A.¹, Donato F.², Gelatti U.³, Cologni G.¹, Costarelli S.¹, Paraninfo G.¹, Lapadula G.¹, Tirelli V.¹, Quiros Roldan E.¹, Moretti F.¹, Casari S.¹, Carosi G.^1
1Dept. of Infectious Diseases- University of Brescia, Brescia, Italy, ²Institute of Hygiene- University of Brescia, Brescia, Italy, ³Dept. of Hygiene- University of Brescia, Brescia, Italy

INTRODUCTION: The actual impact of HAART on liver related mortality is unknown.

AIM: To identify the impact of HAART on Liver Related Death (LRD) in a prospectively followed cohort of HIV infected patients.

METHODS: All in- and out-patients consecutively observed in our Centre from September 1st 1997 to April 1st 1998 have been enrolled. Laboratory tests (including hepatitis markers and HCVRNA or HBVDNA if HCVAb and/or HBsAg positive), complete medical history and alcohol consumption were all assessed at baseline. Patients were followed-up at least every 3 months until April 1st 2004. Life status of patients lost at follow up and causes of death occurring outside Hospital were confirmed by the Regional Health System registry. LRD was defined as a death due to (i) Child C cirrhosisand/or hepatorenal syndrome and/or bleeding of esophageal varices and/or hepatic coma. Cox's proportional hazard model was used to identify risk factors for LRD. HAART related Life Threatening Hepatotoxicity (LTH) was defined as ALT and/or AST increase by >10×UNL or >7.5×UNL in patients whose ALT/AST were abnormal at baseline.

RESULTS: Eight hundred and twelve patients have been enrolled (follow-up: 4,098 person/years; median 6,2 years [IQR 6-6,44]); 129 deaths occurred: 46 Liver related. Independent risk factors for LRD by Cox's proportional hazard model were as follows: HCV infection (HR: 9.2, 95% CI 2.2-38.7; p=0.0024), HBV infection (HR: 2.7, 95% CI 1.5-6.6; p=0.0025), alcohol abuse (HR: 2.7, 95% CI 1.7-5.1; p=0.0017), occurrence of LTH (HR: 5.8, 95% CI 2.6-13.4; p<0.0001), and HAART initiation at CD4+ <350/mm³ (HR 4.6; 95% CI 1.9-11.1 p<0.0001). Use of HAART appeared to be independently protective (HR 0,31 95% CI 0.15-0.61 p<0.0001).

CONCLUSIONS: Maintenance of high CD4 counts by HAART may be necessary, in those with risk factors for liver disease. However prevention and treatment of HAART related LTH is crucial in the same patients.

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Clinical | TuPe2.3C27 | Massimo Puoti
Cardiovascular risk and other toxicities

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