Liver-related deaths in persons infected with the human immunodeficiency virus -: The D:A:D study
Liver-related deaths in persons infected with the human immunodeficiency virus -: The D:A:D study
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DOI：
10.1001/archinte.166.15.1632
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发表时间：
2006-08-14
影响因子：
--
通讯作者：
Weber, Rainer
中科院分区：
文献类型：
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作者：
Weber, Rainer
背景：在接受联合抗逆转录病毒治疗(CART)的人类免疫缺陷病毒感染者中，越来越多的死亡是由于肝病并发症。方法：我们在抗艾滋病毒药物不良事件数据收集研究中调查了肝脏相关死亡的频率和危险因素，对23441名艾滋病毒感染者进行了76893人年的前瞻性随访。多变量Poisson回归分析确定了与肝脏相关、艾滋病相关和其他死因相关的因素。结果：1246例死亡(5.3%；每100人年1.6例)，14.5%死于肝脏相关原因。其中，16.9%为活动性乙肝病毒，66.1%为丙型肝炎病毒，7.1%为双重病毒性肝炎混合感染。与肝脏相关的死亡的预测因素是最近的CD_4细胞计数(调整后的相对比率[RR]，16.1；95%可信区间[CI]，8.1-31.7，50vs>；=500/亩L)，年龄(RR，1.3；95%CI，每5岁为1.2-1.4)，静脉用药(RR，2.0；95%CI，1.2-3.4)，丙型肝炎病毒感染(RR，6.7；95%可信区间4.0~11.2)和活动性乙肝病毒感染(RR=3.7；95%可信区间2.4~5.9)。单变量分析显示，患者接受CART的累积年限与肝脏相关死亡无关(RR，1.00；95%CI，0.93-1.07)。调整最近的CD4细胞计数和患者特征后，CART前每年单一或双重抗逆转录病毒治疗(RR，1.09；95%CI，1.02-1.16；P=.008)和CART每年(RR，1.11；95%CI，1.02-1.21；P=0.02)的肝脏相关死亡风险增加。结论：肝脏相关死亡是非艾滋病相关死亡的最常见原因。我们发现免疫缺陷与肝脏相关死亡的风险之间存在很强的相关性。需要更长的随访时间来调查是否会出现临床上有意义的治疗相关的肝脏相关死亡率。
Background: An increasing proportion of deaths among human immunodeficiency virus (HIV)-infected persons with access to combination antiretroviral therapy (cART) are due to complications of liver diseases.Methods: We investigated the frequency of and risk factors associated with liver-related deaths in the Data Collection on Adverse Events of Anti-HIV Drugs study, which prospectively evaluated 76893 person-years of follow-up in 23441 HIV-infected persons. Multivariable Poisson regression analyses identified factors associated with liver-related, AIDS- related, and other causes of death.Results: There were 1246 deaths ( 5.3%; 1.6 per 100 person-years); 14.5% were from liver-related causes. Of these, 16.9% had active hepatitis B virus ( HBV), 66.1% had hepatitis C virus ( HCV), and 7.1% had dual viral hepatitis coinfections. Predictors of liver-related deaths were latest CD4 cell count ( adjusted relative rate [RR], 16.1; 95% confidence interval [CI], 8.1-31.7 for < 50 vs >= 500/mu L), age ( RR, 1.3; 95% CI, 1.2-1.4 per 5 years older), intravenous drug use ( RR, 2.0; 95% CI, 1.2- 3.4), HCV infection ( RR, 6.7; 95% CI, 4.0-11.2), and active HBV infection ( RR, 3.7; 95% CI, 2.4-5.9). Univariable analyses showed no relationship between cumulative years patients were receiving cART and liver-related death ( RR, 1.00; 95% CI, 0.93-1.07). Adjustment for the most recent CD4 cell count and patient characteristics resulted in an increased risk of liver-related mortality per year of mono or dual antiretroviral therapy before cART ( RR, 1.09; 95% CI, 1.02-1.16; P=.008) and per year of cART ( RR, 1.11; 95% CI, 1.02-1.21; P=.02).Conclusions: Liver-related death was the most frequent cause of non-AIDS-related death. We found a strong association between immunodeficiency and risk of liver related death. Longer follow-up is required to investigate whether clinically significant treatment-associated liver-related mortality will develop.