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  AIDS 2010
18th International AIDS Conference (IAC)
July 18-23 2010
Vienna, Austria
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Liver Death Rate in Spain Similar With and Without HIV, But Only in HCV-Negative
  XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
HIV-infected people in two large Spanish cohorts had a liver-related death rate similar to that of the general population, but only if they did not have hepatitis C virus (HCV) infection [1]. People with HIV and HCV had more than a 20 times higher risk of dying from liver disease than people in the general population. Younger age did not diminish the relative risk of liver-related death in the HIV-positive population.
The study has certain limitations: Only 18 liver-related deaths were recorded, and 16 of them were in people with HCV; there were only a few deaths in some of the subgroups analyzed. Also, the analysis extended only through December 31, 2003 in one cohort and through December 31, 2006 in the other. So cohort members may not have benefited from the latest anti-HCV and antiretroviral therapies.
For this study, the CoRIS-MD cohort included 2518 people in 10 Spanish centers. They entered the cohort from January 1, 1997 and follow-up continued to the end of 2003. All CoRIS-MD members were over 18 years old and had at least 6 months of follow-up. The 2125 CoRIS cohort members included in this analysis came from 31 treatment centers. They joined the cohort from January 1, 2004, and follow-up continued through the end of 2006. CoRIS members were older than 13, had at least 6 months of follow-up, and had not begun antiretrovirals when they entered the cohort.
The investigators recorded liver-related deaths in these cohorts. To calculate a standardized mortality ratio (SMR), the researchers compared liver death rates in people with HIV to rates in a general-population database maintained by the National Institute of Statistics.
Of the 4643 HIV-infected people studied, 18 died during 13,701 person-years of follow-up. Compared with an expected liver death rate for people of the same gender and age in the general population--1.8 deaths--the HIV-positive people had a 10 times higher risk of dying from liver disease (SMR 10.0, confidence interval [CI] 6.3 to 15.9).
Coinfection with HCV largely accounted for the higher liver death rate in the HIV group. Sixteen HCV-seropositive people with HIV and 2 HCV-seronegative people with HIV died of liver disease. The death rate in the HCV group was more than 20 times higher than would be expected in the general population (SMR 20.5, CI 12.6 to 33.5). In contrast, the death rate in the HCV-negative group with HIV was only twice higher than in the general population, and that difference was not significant because the confidence interval crossed 1.0 (SMR 2.0, CI 0.5 to 7.9).
Of the 18 people who died from liver disease, 10 became infected with HIV by injecting drugs, 5 through heterosexual sex, 2 through gay sex, and 1 for an unreported reason. Injection drug use as the route of HIV infection raised the liver death risk 15 times (SMR 15.0, CI 8.1 to 21.0), but liver death risks were also significantly greater in the other two HIV transmission groups than in the general population: SMR 9.4 (CI 3.9 to 22.6) for heterosexual sex, and SMR 4.7 (CI 1.2 to 18.8) for gay sex.
No cohort members between the ages of 18 and 30 died from liver disease. Three people from 30 to 35 died during 3392 person-years of follow-up for a 30 times higher liver-death risk than same-aged people in the general population (SMR 30.0, CI 9.7 to 93.0); 4 people from 35 to 40 died during 4170 person-years for an 11 times higher liver death risk (SMR 10.9, CI 4.1 to 29.0); and 11 people over 40 died in 4221 person-years for an 8 times higher death risk (SMR 8.4, CI 4.7 to 15.2).
Among the 18 HIV-infected people who died, 5 had an AIDS diagnosis and 13 did not. People with an AIDS diagnosis had an 11 times higher risk of liver-related deaths than the general population (SMR 11.2, CI 4.7 to 26.9). But HIV-infected people without AIDS had almost the same excess risk of liver death as people with AIDS (SMR 9.7, CI 5.6 to 16.6).
Five HIV-infected women died during 3766 person-years of follow-up. Compared with women in the general population, HIV-infected women had a 35 times higher risk of liver-related death (SMR 35.4, CI 14.7 to 85.0). Thirteen HIV-infected men died of liver disease during 9936 person-years of follow-up. HIV-positive men had an 8 times higher risk of liver-related death than men in the general population (SMR 7.9, CI 4.6 to 13.6).
1.Cachafeiro P, Lewden C, Hernando V, et al. Liver related mortality in HIV-positive patients compared to liver-related mortality in the general population. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract TUPE0220.