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Mortality for Liver Disease in Patients With HIV Infection: A Cohort Study

Puoti Massimo; Spinetti, Angiola; Ghezzi, Annibale; Donato, Francesco; Zaltron, Serena; Putzolu, Valeria; Quiros-Roldan, Eugenia; Zanini, Barbara; Casari, Salvatore; Carosi, Giampiero; the Hepatitis-HIV Study Group
JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2000

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 liverdisease-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.

Address correspondence and reprint requests to Massimo Puoti, Clinica di Malattie Infettive. Azienda Spedali Civili, Piazza Ospedale 1, I 25123 Brescia, Italy;

Manuscript received January 24. 2000; accepted March 27. 2000.

© 2000 Lippincott Williams & Wilkins, Inc.