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therapy helps, it does
Dec 6, 2003

It helps!

Survival Benefit from Antiretroviral Therapy Far Outweighs Risk of Severe Liver Toxicity

Background HAART has improved the prognosis of HIV infection. However, replication of hepatitis C virus (HCV) is not inhibited by HAART, and treatment-related hepatotoxicity is common.

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.

12/05/03

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

Thanks for your post. BY



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