title: 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.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston, MA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Bica
authors.forename: B
authors.initials: B
authors.lastname: McGovern
authors.forename: R
authors.initials: R
authors.lastname: Dhar
authors.forename: D
authors.initials: D
authors.lastname: Stone
authors.forename: K
authors.initials: K
authors.lastname: McGowan
authors.forename: R
authors.initials: R
authors.lastname: Scheib
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000150:complications; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load