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Electronic letters published:
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Letter to Editor
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Adrian M. Di Bisceglie, MD, FACP Saint Louis University, Karen L. Lindsay M.D., Margaret J. Koziel M.D., David L. Thomas M.D., Robert L. Murphy5M.D., Marion G. Peters M.D.,
Send rapid response to journal:
dibiscam{at}slu.edu Adrian M. Di Bisceglie, et al.
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We read with interest the recent article by Sackoff and colleagues on causes of death among persons with AIDS in the HAART era in New York City (1). This is a comprehensive analysis of non-HIV causes of death and may be representative of patterns in the United States as a whole. The authors conclude that the proportion of deaths due to non-HIV-related causes increased by 33% between 1999 and 2004 and they suggest that these findings require a shift in the provision of health care for persons with AIDS from a focus on HIV infection to a model that encompasses other aspects of physical and mental health. This shift in causes of death represents a major triumph of medical care in the United States, but the authors’ analysis exposes another significant health problem in persons with HIV infection, namely death due to hepatitis and liver disease. Although liver disease is not included specifically in the authors’ top ten list of non-HIV causes of death, when the individual categories of hepatitis C, liver cancer and cirrhosis of the liver are combined, they account for the third largest category after complications of drug abuse and dependency and chronic ischemic heart disease. In addition, the contributions of alcohol abuse/ dependence and drug abuse/ dependence to liver disease are not accounted for and may increase this category substantially. It is estimated that 30% of HIV-infected individuals in the United States are co-infected with the hepatitis C virus (HCV) and a further 5- 10% with the hepatitis B virus (HBV) (2,3,4). These chronic viral infections, together with alcohol abuse and diabetes, are major contributors to cirrhosis and liver cancer. Although current treatments for alcoholic liver disease and non-alcoholic steatohepatitis remain inadequate, considerable progress has been made towards developing effective therapies for chronic hepatitis B and hepatitis C and these therapies have the potential to reduce the rates of death and liver cancer. Further studies are needed to ascertain whether treatment of hepatitis C and hepatitis B viral will also reduce the mortality rate from liver disease in HIV positive persons. In summary, we feel it is important to recognize the significant contribution of hepatitis and liver disease to morbidity and mortality associated with HIV infection and AIDS. Clearly, considerable further research is needed into causes and treatment of chronic liver disease in persons with AIDS, and liver disease should be specifically addressed in future models of health care provision for persons infected with HIV. Conflict of Interest:None declared |
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