Mortality for liver disease in patients with HIV infection: a cohort study.
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.
Puoti
M
M
II Divisione di Malattie Infettive, Azienda Spedali Civili, Brescia, Italy. puoti_brambilla@iol.it
Spinetti
A
A
Ghezzi
A
A
Donato
F
F
Zaltron
S
S
Putzolu
V
V
Quiros-Roldan
E
E
Zanini
B
B
Casari
S
S
Carosi
G
G
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality; D000328:Adult; D000437:Alcoholism / Q000401:mortality; D000914:Antibodies, Viral / Q000032:analysis; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D003698:Hepatitis Delta Virus / Q000276:immunology; D006525:Hepatitis, Viral, Human / Q000209:etiology / Q000401:mortality; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000276:immunology / Q000401:mortality; D017093:Liver Failure / Q000150:complications / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors
D000914:Antibodies, Viral; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens