A team from the USA retrospectively examined the causes of death of HIV-seropositive patients at a single institution in 1991, 1996, and 1998-1999.
As highly active anti-retroviral therapy has decreased human immunodeficiency virus (HIV)-associated mortality, other comorbidities - such as chronic liver disease - have assumed greater importance.
|Deaths in HIV-serpositive patients due to end-stage liver disease:|
|Clinical Infectious Diseases|
The researchers found that between 1998 and 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.
In 1998-1999, 55% of patients had non-detectable plasma HIV RNA levels and/or CD4 cell counts of greater than 200 cells/mm3 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 were found to have antibodies, 57.7% who died in 1996, and 93.8% who died in 1998-1999.
In addition, between 1998 and 1999, 7 patients (31.8%) discontinued antiretroviral therapy because of hepatotoxicity, compared with 0 in 1991, and 2 (5.6%) in 1996.
Ioana Bica, of the Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston, concluded on behalf of the group, "End-stage liver disease is now the leading cause of death in our hospitalized HIV-seropositive population."