Mocroft Amanda, Soriano Vincent, Rockstroh Jurgen, Reiss Peter, Kirk Ole, de Wit Stephane, Gatell Jose, Clotet Bonaventura, Phillips Andrew N, Lundgren Jens D
Royal Free Centre for HIV Medicine and Dept Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
AIDS. 2005 Dec 2;19(18):2117-25. doi: 10.1097/01.aids.0000194799.43799.ea.
Increases in deaths due to liver-related disease (LRD) among HIV-infected individuals have been reported although the influence of combination antiretroviral therapy (cART) on LRD is controversial.
To determine changes over time in the death rate from LRD and if longer exposure to cART was associated with an increased death rate from LRD in 10 937 patients from EuroSIDA, an observational longitudinal cohort study.
A total of 184 (1.7%) died from LRD during 52 236 person-years of follow-up (PYFU). The death rate from LRD declined from 6.9 per 1000 PYFU before 1995 [95% confidence interval (CI), 3.9-9.9] to 2.6 at/after 2004 (95% CI, 1.6-4.0). When the current CD4 cell count and other factors were taken into account, there was a 13% increase in the death rate from LRD per year (95% CI, 5-20%, P = 0.0008). In patients who had started cART, there was a 12% increase in the death rate from LRD per additional year exposure to cART (95% CI, 4-20%, P = 0.022) after adjustment for current CD4 cell count and other factors.
Death rates from LRD appeared to decrease across Europe. However after adjustment for the current CD4 cell count, and therefore increases in CD4 cell counts in patients taking cART, there was a significant increase over time in death rates from LRD. In patients with similar CD4 cell counts, longer exposure to cART was associated with an increased death rate from LRD. This may be due to direct liver toxicity of antiretrovirals, progression of liver disease due to hepatitis B virus or hepatitis C virus over time as patients survive longer, or some other factor.
尽管联合抗逆转录病毒疗法（cART）对肝脏相关疾病（LRD）的影响存在争议，但已有报道称感染HIV的个体中因LRD导致的死亡人数有所增加。
在一项观察性纵向队列研究——欧洲艾滋病临床数据库（EuroSIDA）的10937例患者中，确定LRD死亡率随时间的变化，以及更长时间接受cART是否与LRD死亡率增加相关。
在52236人年的随访（PYFU）期间，共有184例（1.7%）死于LRD。LRD死亡率从1995年之前的每1000人年6.9例[95%置信区间（CI），3.9 - 9.9]降至2004年及之后的每1000人年2.6例（95% CI，1.6 - 4.0）。在考虑当前CD4细胞计数和其他因素后，LRD死亡率每年增加13%（95% CI，5 - 20%，P = 0.0008）。在开始接受cART的患者中，在调整当前CD4细胞计数和其他因素后，每多接受一年cART，LRD死亡率增加12%（95% CI，4 - 20%，P = 0.022）。
在欧洲，LRD死亡率似乎有所下降。然而，在调整当前CD4细胞计数（即接受cART患者的CD4细胞计数增加）后，LRD死亡率随时间显著增加。在CD4细胞计数相似的患者中，更长时间接受cART与LRD死亡率增加相关。这可能是由于抗逆转录病毒药物的直接肝脏毒性、随着患者存活时间延长，乙型肝炎病毒或丙型肝炎病毒导致的肝脏疾病进展，或其他一些因素。
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