LIVER-RELATED MORTALITY DURING THE HAART ERA IN MACS AND WIHS
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It is not clear how the risk of liver-related mortality (LRM) among people infected with HIV has changed during the 20 years since the introduction of HAART; Thus, this study was designed to 1) characterize changes in all-cause mortality and LRM rates since the introduction of HAART in 1996, and 2) examine the effect of HIV/viral hepatitis co- infection on LRM among those infected with HBV or HCV. Methods: This observational cohort study included all participants with known HBV and HCV status being followed in the Multicenter Center AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS) between 1996 and 2013. Poisson and Cox regression methods were used to examine the rate of and risk factors for the study outcomes of all-cause mortality and LRM. Results: The overall all-cause mortality and LRM rates during the study period were 15.2 and 2.3 per 1000 person-years, respectively. Following adjustment, all-cause mortality decreased significantly by 3.6% (95% CI: 2.2% - 5.1%) while LRM did not (decreased by 2.2% (95% CI: -1.7% - 5.8%) annually). Importantly, both all-cause mortality and LRM decreased over time among those with CH-B and increased among those with CH-C. Adjusted for age, race, education, income, and blood pressure, CH-B, CH-C and HIV infection were independently associated with a higher LRM (HRs of 9.09 (95% CI, 5.35 – 15.43), 11.63 (95% CI, 7.52 – 17.98), and 1.84 (95% CI, 0.99 – 3.42), respectively), and HAART use was significantly associated with a lower LRM risk (HR, 0.61; 95% CI, 0.42 – 0.88). Conclusions: During the 20 years since HAART was introduced, liver disease has become an increasingly important cause of death among people infected with HIV. Although CH-B was associated with higher LRM during the early HAART era, LRM has been higher among those with CH-C in recent years; a shift that might be related to our findings that HARRT was associated with lower LRM. Collectively, the findings from our study suggest that there is an urgent need to increase the awareness of hepatitis among people infected with HIV, and that effective strategies to prevent, detect, and treat hepatitis infections are important in this population.