Increasing Mortality Due to End-Stage Liver Disease in Patients with Human Immunodeficiency Virus Infection

Abstract

Highly active antiretroviral therapy has decreased human immunodeficiency virus (HIV)-associated mortality; other comorbidities, such as chronic liver disease, are assuming greater importance. We retrospectively examined the causes of death of HIV-seropositive patients at our institution in 1991, 1996, and 1998-1999. In 1998-1999, 11 (50%) of 22 deaths were due to end-stage liver disease, compared with 3 (11.5%) of 26 in 1991 and 5 (13.9%) of 36 in 1996 (P=.003). In 1998-1999, 55% of patients had nondetectable plasma HIV RNA levels and/or CD4 cell counts of >200 cells/mm(3) within the year before death. Most of the patients that were tested had detectable antibodies to hepatitis C virus (75% of patients who died in 1991, 57.7% who died in 1996, and 93.8% who died in 1998-1999; P=NS). In 1998-1999, 7 patients (31.8%) discontinued antiretroviral therapy because of hepatotoxicity, compared with 0 in 1991 and 2 (5.6%) in 1996. End-stage liver disease is now the leading cause of death in our hospitalized HIV-seropositive population.

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…Liver disease has become a growing concern in HIV/AIDS and is the leading cause of death in patients with HIV. 81,82 In the D:A:D study, viral hepatitis was the commonest cause of death (84% of liver-related deaths and 11% of all-cause mortality). Hepatitis C was the most common viral hepatitis coinfection seen in HIV.…”

Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus

“…[1][2][3][4] Despite a decline in morbidity and mortality from opportunistic infections since the introduction of highly active antiretroviral therapy (HAART), end-stage liver disease continues to be a frequent cause of hospital admission and death in populations coinfected with HIV and hepatitis C virus (HCV). 5,6 For this reason, all HIVinfected individuals with positive HCV RNA determinations should be considered as candidates for anti-HCVtreatment, providing HIV infection is wellcontrolled and there are no contraindications to therapy with interferon or ribavirin. [7][8][9][10] It is known that response to antiviral therapy appears to reduce liver complications in chronic hepatitis C 11,12 ; however, little is known about the clinical consequences of achieving a sustained virological response (SVR) following therapy with interferon plus ribavirin in coinfected patients.…”

Erratum to: Cholestatic Hepatitis C in Immunocompromised Settings

“…This rate of coinfection is not surprising given that HIV and HCV are acquired through similar routes, although at different rates. With the introduction of highly active antiretroviral therapy (HAART) in 1996, HIV mortality declined and HCVrelated liver disease is now the leading cause of morbidity and mortality in HIV-infected persons [31]. Progression of liver disease in patients with HIV/HCV coinfection is also accelerated.…”