This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • HIV/AIDS  • Adverse Effects  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

The D:A:D Study

The Data Collection on Adverse Events of Anti-HIV Drugs Study Group^*

Arch Intern Med. 2006;166:1632-1641.

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 76 893 person-years of follow-up in 23 441 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 co-infections. 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/µL), 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.

*Authors/Writing Committee: The following members of the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group take authorship responsibility for the D:A:D Study: Rainer Weber, MD; Caroline A. Sabin, PhD; Nina Friis-Møller, MD, PhD; Peter Reiss, MD, PhD; Wafaa M El-Sadr, MD, PhD; Ole Kirk, MD, DMSc; Francois Dabis, MD, PhD; Matthew G. Law, PhD; Christian Pradier, MD, PhD; Stephane De Wit, MD, PhD; Börje Åkerlund, MD; Gonzalo Calvo, MD; Antonella d’Arminio Monforte, MD, DMSc; Martin Rickenbach, MD; Bruno Ledergerber, PhD; Andrew N. Phillips, PhD; and Jens D. Lundgren , MD, DMSc.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Saquinavir exposure in HIV-infected patients with chronic viral hepatitis
Molto et al.
J Antimicrob Chemother 2009;63:992-997.
ABSTRACT | FULL TEXT  

Trends in HIV/TB Coinfection in Trinidad and Tobago for the Period 1998-2007
Mungrue et al.
J Int Assoc Physicians AIDS Care (Chic Ill) 2009;8:170-175.
ABSTRACT  

Effect of Early versus Deferred Antiretroviral Therapy for HIV on Survival
Kitahata et al.
NEJM 2009;360:1815-1826.
ABSTRACT | FULL TEXT  

The Challenge of Finding a Cure for HIV Infection
Richman et al.
Science 2009;323:1304-1307.
ABSTRACT | FULL TEXT  

Influence of liver fibrosis stage on plasma levels of efavirenz in HIV-infected patients with chronic hepatitis B or C
Meynard et al.
J Antimicrob Chemother 2009;63:579-584.
ABSTRACT | FULL TEXT  

Effect of atazanavir versus other protease inhibitor-containing antiretroviral therapy on endothelial function in HIV-infected persons: randomised controlled trial
Flammer et al.
Heart 2009;95:385-390.
ABSTRACT | FULL TEXT  

HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity
Deeks and Phillips
BMJ 2009;338:a3172-a3172.
FULL TEXT  

Seroprevalence of HIV/HBV Coinfection in Malian Blood Donors
Tounkara et al.
J Int Assoc Physicians AIDS Care (Chic Ill) 2009;8:47-51.
ABSTRACT  

Risk for Opportunistic Disease and Death after Reinitiating Continuous Antiretroviral Therapy in Patients with HIV Previously Receiving Episodic Therapy: A Randomized Trial
The SMART Study Group
ANN INTERN MED 2008;149:289-299.
ABSTRACT | FULL TEXT  

Antiretroviral Treatment of Adult HIV Infection: 2008 Recommendations of the International AIDS Society-USA Panel
Hammer et al.
JAMA 2008;300:555-570.
ABSTRACT | FULL TEXT  

Gastrointestinal complications of HIV infection: changing priorities in the HAART era
Wilcox and Saag
Gut 2008;57:861-870.
ABSTRACT | FULL TEXT  

Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial
Soriano et al.
J Antimicrob Chemother 2008;61:200-205.
ABSTRACT | FULL TEXT  

Comorbidities in older patients with HIV: A retrospective study
Magalhaes et al.
Journal of the American Dental Association 2007;138:1468-1475.
ABSTRACT | FULL TEXT  

Improved survival in HIV-infected persons: consequences and perspectives
Lohse et al.
J Antimicrob Chemother 2007;60:461-463.
ABSTRACT | FULL TEXT  

Serious Non-AIDS Conditions: Redefining the Spectrum of HIV-Related Disease
AIDS Clin Care 2007;2007:1-1.
FULL TEXT  

Viral hepatitis in HIV infection.
Cross et al.
NEJM 2007;357:90-91.
FULL TEXT  

Viral Hepatitis in HIV Infection
Koziel and Peters
NEJM 2007;356:1445-1454.
FULL TEXT  

Liver-Related Deaths in HIV Patients
AIDS Clin Care 2006;2006:2-2.
FULL TEXT