Increasing Mortality Due to End-Stage Liver Disease in Patients with Human Immunodeficiency Virus Infection

TLDR

Highly active antiretroviral therapy has reduced HIV mortality, making chronic liver disease a growing cause of death. The authors retrospectively reviewed death causes among HIV‑positive patients at their institution in 1991, 1996, and 1998–1999. In 1998–1999, end‑stage liver disease accounted for 50 % of deaths (vs 11.5 % in 1991 and 13.9 % in 1996), with most patients having detectable hepatitis C antibodies, 55 % having suppressed HIV, and 31.8 % having discontinued antiretroviral therapy due to hepatotoxicity, establishing liver disease as the leading cause of death.

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/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, 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.