Dissident AIDS Database

HIV drugsAZT/PIsSide effectsCauses of death
Evolution of causes of death in patients infected by HIV in the Aquitaine Troop 1985-1997
 Vandorten p;Mercié c;f Dabis and the clinical group of epidemiology in Aquitaine
  "The proportion of the causes of deaths not aids passes from 15.2% of the deaths in 1995 to.....35.1% in 1997. The comparison of the causes of death before (jan 95 - june 96) and after the introduction of the PI ( July 1996 december 1997) highlights a tendency at the increase in the cause of death by neoplasic pathologies, classifying AIDS or not (from 18% to 23%). This phenomenom is amplified when one compares the whole of the period before the introduction of the period and the 18 months following".
  bulletin épidémiologique hebomadaire, N°17, 27 avril 19991999
HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)
 Chloe L Thio, Eric C Seaberg, Richard Skolasky Jr, John Phair, Barbara Visscher, Alvaro Muñoz, David L Thomas
  Although coinfection with HIV-1 and hepatitis B virus (HBV) is common, few long-term studies on liver-disease mortality in coinfected people have been undertaken. Our aim was to examine liver-related mortality among people at risk for HIV-1 and HBV infections. We used data from a multicentre, prospective cohort study to classify 5293 men who had sex with men, according to their HIV-1 antibody status, ascertained semiannually, and their hepatitis-B surface antigen status (HBsAg), which we ascertained at baseline. Mortality rates were estimated in terms of person-years and Poisson regression methods were used to test for signifiance of relative risks... In coinfected individuals, the liver-related mortality rate was highest with lower nadir CD4+ cell counts and was twice as high after 1996, when highly active antiretroviral therapy (HAART) was introduced.
  Lancet 2002; 360: 1921-262002
 No author
  Up to one third of HIV patients have mild to moderate elevations in ALT (alanine transamine) and AST (aspartamine transamine)... Elevations in these enzymes signal injury to liver cells and, in some cases, to other cells in the body. The condition can result from highly active anti-retroviral therapy (HAART), viral hepatitis or alcohol abuse, all of which are toxic to liver cells. Liver failure is the most common cause of death in people with AIDS. While ALT and AST testing is routine in monitoring of HIV patients, elevations are not typically addressed unless they are more than twice what is considered normal. The standard remedy for extremely high ALT and AST levels is to stop or change antiretroviral medications and to counsel patients to stop drinking alcohol. Mild to moderate elevations (0.5 up to 2 times the normal level) currently are not treated. The Pittsburgh-led study was an analysis of data on more than 5,700 participants from two observational studies: Collaborations in HIV Research - U.S. (CHORUS), composed largely of white men who contracted HIV from homosexual activity, and women who contracted HIV from heterosexual activity or intravenous drug use; and the Veterans Aging Cohort Study (VACS), composed mainly of African American men who contracted HIV from heterosexual activity or intravenous drug use. Study participants with mild to moderate elevations had an increased risk of death that was 1.73 times the risk of those with mid-range normal enzyme levels. Those with two or more times the normal enzyme levels had a 5.06 increased risk of death. Results were consistent in both the CHORUS and VACS cohorts... Furthermore, the fact that the most common current cause of death among people with HIV is liver failure suggests that liver injury may be a major limiting factor in the effectiveness of current HIV treatment." In a related poster on display at the conference, Dr. Justice and colleagues relay findings from a study showing that incidence of liver cancer among HIV-positive veterans since the advent of HAART is nearly twice as high as it is for HIV-negative veterans. The researchers indicate that possible reasons for the increase may include drug toxicity and viral hepatitis... "This association with increased mortality suggests that any elevation in ALT and AST should be addressed."
  News Bureau, PITTSBURGH, July 8, 20022002
Increasing Mortality Due to End-Stage Liver Disease in Patients with Human Immunodeficiency Virus Infection.
 McGovern B et al.
  “ In 1998-1999, 11 (50%) of 22 deaths were due to end-stage liver disease, compared with 3 (11.5%) of 26 in 1991 and 5 (13.9%) of 36 in 1996 (P = .003)... End-stage liver disease is now the leading cause of death in our hospitalized HIV-seropositive population.”
  Clin Infect Dis. 2001 Feb 1;32:492-4972001
Immune Restoration With Antiretroviral Therapies: Implications for Clinical Management.
 Lederman MM, Valdez H.
  “There is reason to be concerned that the spectrum of morbidity and mortality in HIV disease is changing rapidly to include metabolic complications of therapies and infectious complications, such as hepatitis C. Of recent HIV-related deaths occurring in the John Carey Special Immunology Unit of University Hospitals of Cleveland (number of deaths ranging from 20 in 1998 to 32 in 1999), although OIs [Opportunistic Infections] constituted less than 25% of deaths in 1999, end-organ failures [which could well be caused by medication] constituted nearly half. Importantly, the median CD4 cell count among the patients who died in our clinic has risen, from 0/L in 1995 to 75 million/L in 1999, and about 20% of recent deaths have occurred among patients with plasma HIV RNA levels below the limit of detection.”
  JAMA. 2000 Jul 12;284(2):223-82000
hivresistance web : ask the experts
 Conway Brian
  ..."in addition, long-term use of HAART has now been associated with significant metabolic abnormalities which could lead to unintended morbidity. In some patients, this morbidity could be worse than what one could expect from the progression of HIV-associated immune disease itself over the same period of time..."