therapy helps, it does
Dec 6, 2003
Survival Benefit from Antiretroviral Therapy Far Outweighs Risk of Severe Liver Toxicity
To clarify the effect of HAART in HIV/HCV-coinfected patients, researchers at the University of Bonn, Bonn, Germany, studied liver-related mortality and overall mortality in 285 patients who were regularly treated during the period 1990-2002 at our department.
Survival was analysed retrospectively by Kaplan-Meier and Cox's regression analyses after patients (81 haemophiliacs) had been stratified into three groups according to their antiretroviral therapy (HAART n=93, available after 1995; treatment exclusively with nucleoside analogues n=55, available after 1992; or no treatment, n=137).
Study Results Liver-related mortality rates were 0.45, 0.69, and 1.70 per 100 person-years in the HAART, antiretroviral-treatment, and untreated groups. Kaplan-Meier analysis of liver-related mortality confirmed the significant survival benefit in patients with antiretroviral therapy (p=0.018), and regression analysis identified HAART (odds ratio 0.106), antiretroviral treatment (0.283), CD4-positive T-cell count (0.746 per 0.05x10(9) cells/L), serum cholinesterase (0.962 per 100 U/L), and age (1.065 per year) as independent predictors of liver-related survival.
Severe drug-related hepatotoxicity was seen in five patients treated with nucleoside analogues alone and 13 treated with HAART. No patient died from drug-related hepatotoxicity.
Conclusions In addition to improved overall survival, antiretroviral therapy significantly reduced long-term liver-related mortality in our patients. This survival benefit seems to outweigh by far the associated risks of severe hepatotoxicity.
Reference N Qurishi and others. Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection. Lancet 362(9397): 1708-1713. November 22, 2003.
Response from Dr. Young
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