International AIDS Society

Low CD4 Count, Not ART, Drives Higher Liver Disease/Death Rates

Author: Mark Mascolini

09 July 2012

Low CD4 counts and high HIV loads accounted for much of the impact of HIV infection on hepatic dysfunction and liver-related death in a large US case-control comparison. Longer time on antiretroviral therapy (ART) did not affect risk of liver dysfunction or death.

Interactions between chronic HIV infection and liver disease and death remain incompletely understood. To characterize the hepatic risks of HIV infection, low CD4 count, and cumulative ART, US researchers conducted this case-control comparison.

The analysis included HIV-positive adults, each of them matched to 10 HIV-negative individuals by age and gender. Follow-up continued to track rates of new hepatic dysfunction or hepatic dysfunction-related death. Statistical analysis to compare liver dysfunction and death rates in HIV-positive and negative people accounted for several hepatic risk factors, including alcohol or drug abuse, hepatitis B or C infection, and diabetes.

The study included 20,775 HIV-positive people and 215,158 controls without HIV. Compared with HIV-negative controls, the HIV-positive group had a significantly greater overall risk of both hepatic dysfunction and hepatic dysfunction-related death.

HIV-positive people with low CD4 counts had almost a 60 times greater rate of liver death (adjusted rate ratio [aRR] 59.4, 95% confidence interval [CI] 39.3 to 89.7, P < 0.001) and almost a 16 times higher rate of hepatic dysfunction (aRR 15.7, 95% CI 11.4 to 21.6, P < 0.001).

Statistical analysis involving only people with HIV identified several factors that raised the risk of hepatic dysfunction or death: low CD4 cell count, high HIV load, alcohol or drug abuse, hepatitis B or C coinfection, and diabetes. Longer time taking ART did not raise the risk of liver dysfunction or death, regardless of what antiretroviral class was used.

“HIV-infected individuals have a higher risk of hepatic dysfunction and hepatic dysfunction-related death compared with HIV-uninfected individuals,” the researchers conclude, “even with adjustment for known hepatic risk factors.”

They suggest their findings “provide indirect evidence supporting early use of ART to reduce the risk for hepatic-related complications.”

Source: William J. Towner, Lanfang Xu, Wendy A. Leyden, Michael A. Horberg, Chun R. Chao, Beth Tang, Daniel B. Klein, Leo B. Hurley, Charles P. Quesenberry, Jr, Michael J. Silverberg. The effect of HIV infection, immunodeficiency, and antiretroviral therapy on the risk of hepatic dysfunction. JAIDS. 2012; 60: 321-327.

For the study abstract

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