Excess liver‐related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death

Abstract

Liver diseases have become a leading cause of death among people with AIDS (PWA). This study aimed to investigate whether PWA experienced excess mortality related to liver diseases as compared to the general population (non-PWA), using a multiple cause of death (MCoD; i.e. all conditions reported on death certificates) approach. Methods A population-based, nationwide, retrospective cohort study was conducted among Italian people, aged 15-74 years, who had been diagnosed with AIDS since 2006. Date of death and MCoD data were retrieved, up to December 2015, by individual record linkage with national mortality data. Sex-and age-standardized mortality ratios (SMRs), with 95% confidence intervals (CIs), were estimated by dividing the observed number of deaths related to a specific condition among PWA to the expected number, based on non-PWA mortality rates. Results Among 7912 PWA (34 184 person-years), 2076 deaths occurred. The number of death certificates reporting liver diseases among MCoDs was 583 (28.1%), including 382 (18.4%) reporting viral hepatitis, 370 (17.8%) reporting nonviral liver diseases, and 41 (2.0%) reporting liver cancers. The corresponding SMRs were 40.4 (95% CI 37.2-43.8) for all liver diseases, 131.1 (95% CI 118.3-145.0) for viral hepatitis, 29.9 (95% CI 27.0-33.1) for nonviral liver diseases, and 11.2 (95% CI 8.1-15.3) for liver cancers. Particularly elevated SMRs emerged among PWA aged 15-49 years and those infected by injecting drug use. Conclusions The high excess liver-related mortality observed among PWA warrants preventive actions to limit the burden of viral hepatitis coinfections, alcohol abuse, and metabolic disorders, especially among younger PWA and injecting drug users.

Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis

“…Several recent studies found that PLHIV have relatively poorer prognosis and survival for some NADCs in comparison with the general population. 54 , 55 , 56 , 57 , 58 For example, studies conducted in the US reported elevated standardized mortality ratios (SMRs) for some common NADCs, such as cancers of the liver, lung, and colon and rectum in PLHIV. 56 , 57 , 58 Understanding the risk of death attributable to various NADCs could inform disease management and treatment among PLHIV.…”

“… 54 , 55 , 56 , 57 , 58 For example, studies conducted in the US reported elevated standardized mortality ratios (SMRs) for some common NADCs, such as cancers of the liver, lung, and colon and rectum in PLHIV. 56 , 57 , 58 Understanding the risk of death attributable to various NADCs could inform disease management and treatment among PLHIV. To the best of our knowledge, however, so far there has been a lack of summary and meta-analysed data on the mortality risk of NADCs among PLHIV.…”

Effects of Chinese Medicine on the Survival of AIDS Patients Administered Second-Line ART in Rural Areas of China: A Retrospective Cohort Study Based on Real-World Data

“…Although we used PSM to control for selection bias, a retrospective cohort study is intrinsically biased. Furthermore, specific important variables associated with mortality, such as adherence to ART, body mass index, anemia, hyperlipemia, and liver injury [ 31 – 33 ], were not recorded when patients switched to second-line ART.…”

Determinants of Survival Among HIV/AIDS Patients With The Second-Line Antiretroviral Therapy In Henan Province of China 

“…AST/ALT≥50 u/L, which was de ned as Liver injury [26], was the risk factor of death of HIV/AIDS patients. Liver injury would induce cirrhosis and hepatocellular carcinoma and increase the HR of death in HIV/AIDS patients [27,28].…”