After receiving reports of increased deaths due to liver disease in PHAs, a team of doctors in Boston decided to review medical records at its hospital to find out if more PHAs were indeed dying of complications from liver disease. The doctors looked at data from three points in time — 1991, 1996 and 1998-1999. According to their review of 84 deaths, 50% of deaths in 1998-1999 occurred because of complications from liver damage. The possible reasons for this are discussed later in the report below.
The proportion of PHAs who died from complications due to liver disease in each time point was as follows:
The remaining proportion of PHAs died from complications due to AIDS. One year before subjects with liver-related disease died, 50% of them had CD4+ counts greater than 200 cells or a viral load below the 500 copy mark.
The doctors conducting the review were unable to find out from medical records how long the PHAs who died of liver disease had been co-infected with hepatitis C virus (HCV). They did note that the proportion of PHAs who were tested for exposure to HCV increased over time:
In 1998-1999, 11 subjects died from complications due to liver damage; 9 out of 10 of these tested positive for HCV.
Studies reviewing old medical records (retrospective studies) can be helpful as they identify patterns that may have occurred. The results of these findings confirm the suspicions in the AIDS community that there has been an increase in liver-related deaths in the late 1990s in North America. Deaths due to liver disease may be increasing for a number of reasons. For instance, because of highly active antiretroviral treatment (HAART), PHAs are no longer dying in large numbers from formerly common AIDS-related complications such as PCP (Pneumocystis carinii pneumonia), CMV (cytomegalovirus) infections and weird bacterial and parasitic disesases. They are living longer, which allows more time for HCV to inflict damage on the liver — damage that has fatal consequences.
Another possible reason for the increase in liver-related deaths is that as people are living longer because of HAART, their exposure to potentially liver-damaging drugs increases compared to the time before HAART.
Studies are needed to determine the following:
REFERENCE
1. Bica I, McGovern B, Dhar R, et al. Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clinical Infectious Diseases 2001;32(3):492-497.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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