Mortality for liver disease in patients with HIV infection: A cohort study

II Divisione di Malattie Infettive, Azienda Spedali Civili, Brescia, Italy.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 08/2000; 24(3):211-7. DOI: 10.1097/00042560-200007010-00003
Source: PubMed

ABSTRACT We undertook this study to assess the association between the various potential causes of liver disease in HIV-seropositive patients and mortality due to liver failure. Three hundred and eight in-hospital deaths were observed from 1987 to December 1995 in a prospectively followed cohort of 1894 HIV-seropositive patients. For each study subject, clinical data were evaluated to assess whether liver failure had substantially contributed to mortality. A case control study nested in the cohort was then performed, which compared demographic and clinical variables observed at enrollment and during follow-up between patients who died for liver disease as the main or concurrent cause of death (cases) and those who died as a result of illness related to AIDS or other causes (controls). Among 308 in-hospital deaths, liver failure was found the cause of death in 35 patients (12%); in 16 cases, it was the primary cause and in 19 cases it was concurrent. Multivariate analysis showed that in-hospital liver-disease-related mortality was independently associated with hepatitis B surface antigen reactivity (odds ratio [OR], 9; 95% confidence interval [CI], 3.8-21.7) and history of alcohol abuse (OR, 2.3; 95% CI, 1-5.2). Prevention and treatment of hepatitis B virus infection and alcohol intake are management priorities in HIV-seropositive patients.

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    • "In the HAART era, HAC in HIV-infected patients has been associated with increased mortality (Braithwaite et al., 2007; Di Martino et al., 2001; Galai et al., 2005; Hooshyar et al., 2007; Lewden et al., 2005; Puoti et al., 2000; Rosenthal et al., 2003, 2007), mostly from liver diseases (Di Martino et al., 2001; Lewden et al., 2005; Puoti et al., 2000; Rosenthal et al., 2007) and particularly in women (Hessol et al., 2007). Recent heroin and cocaine use as well as homelessness, have also been identified as major determinants of early mortality in *Corresponding author. "
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    ABSTRACT: Alcohol abuse affects secondary prevention and disease progression in HIV-infected patients, and adherence and response to treatment in those chronically treated. The objective of this study was to estimate the prevalence of harmful alcohol consumption (HAC) using various indicators and identify which groups of patients may require specific targeted interventions for HAC risk reduction. A cross-sectional survey, based on a random sample representative of people living with HIV/AIDS (PLWHA) was carried out in 102 French hospital departments delivering HIV care. As alcohol abuse is particularly detrimental to patients receiving highly active antiretroviral therapy (HAART), we focused only on those individuals receiving HAART with complete alcohol assessment (CAGE, AUDIT-C, regular binge drinking, N=2340). Collected information included medical and socio-demographic data, HIV risk behaviors, adherence to treatment and substance and alcohol use, together with depression, anxiety, and experience of attempted suicide or sex work. HAC prevalence was evaluated as follows: 12% (CAGE score > or =2), 27% (AUDIT-C), and 9% (regular binge drinking). Three groups were at higher risk of HAC: men who have sex with men using stimulants, polydrug users, and to a lesser degree, ex-drug users. Innovative intervention strategies to reduce HAC and improve HIV prevention and HAART adherence in various PLWHA populations need urgent testing and implementation. Such interventions for alcohol risk reduction remain central to promoting improved HIV prevention and assuring HAART effectiveness in these populations.
    AIDS Care 09/2010; 22(9):1136-45. DOI:10.1080/09540121003605039 · 1.60 Impact Factor
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    • "In patients already infected with HIV and either hepatitis B or C, the prognosis is made much worse with additional infection by other hepatotropic viruses [1] [2] [3]. Evidence from HIV-negative patients shows a rate of acute fulminant hepatitis of up to 40% when a chronic hepatitis C carrier subsequently gets hepatitis A or B [4] [5] [6]. "
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    ABSTRACT: Co-infection of HIV-positive patients with hepatitis viruses worsens the long-term prognosis and this is summative for each new infection in any individual. Vaccination against hepatitis A or B may be effective but response rates are reduced in HIV infected patients. Improvement in response can be induced through extra doses, higher doses and HAART-induced increase in the CD4 count. Hepatitis B and C may also be prevented through counselling about safer sex, particularly condom use. In intravenous drug users, harm reduction, counselling and the use of needle/syringe exchange schemes may be helpful.
    Journal of Hepatology 02/2006; 44(1 Suppl):S104-7. DOI:10.1016/j.jhep.2005.11.022 · 10.40 Impact Factor
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    • "Prevalence of hepatitis C virus (HCV) infection among anti-human immunodeficiency virus (HIV) seropositive patients with a history of intravenous drug use (IDU) or transfusion is greater than 80%. The extensive use of highly active antiretroviral therapy (HAART) has dramatically changed the prognosis of HIV infection, prolonging and improving life of anti-HIV seropositives [1]. On the other hand, mortality and morbidity for liver disease have increased significantly [2]. "
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    ABSTRACT: Interferon and ribavirin combination therapy for chronic hepatitis C induces a low response rate in human immunodeficiency virus (HIV) infected patients. To assess the impact of intensification of interferon administration and of the addition of amantadine on the efficacy and safety of standard anti-hepatitis C virus (HCV) treatment in HIV-infected patients. Multicentre, prospective, open-label, randomized, phase III clinical trial. Eighty co-infected patients were randomized to receive ribavirin 800-1,000 mg/day in combination with, group A: interferon alpha 2a 3MIU thrice weekly; group B: IFN alpha 2a 3MIU daily, plus amantadine 200 mg/day; treatment duration was 24-48 weeks according to HCV genotype. Forty-one patients were randomized in group A and 39 in group B. Intention-to-treat analysis showed a sustained virological response, defined as HCV-RNA negativization, 6 months after stopping treatment in 22% of patients from group A and 13% from group B (P>0.05). The lack of a 2-log drop in HCV-RNA levels after 12 weeks of treatment showed a 100% predictive value of lack of sustained response. Amantadine addition and interferon intensification do not improve the low efficacy of combination of interferon alfa plus ribavirin in HIV/HCV co-infected patients. Patients with no early virologic response did not have any probability of sustained response.
    Journal of Hepatology 09/2004; 41(2):312-8. DOI:10.1016/j.jhep.2004.04.016 · 10.40 Impact Factor
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