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Researchers: HCV, HBV, alcohol use associated with ESLD in patients with HIV

BOSTON — More than 30% of end-stage liver disease occurrences could be avoided by avoiding hepatitis C virus infection and at-risk alcohol use. Treating these traditional modifiable risk factors for end-stage liver disease may act as preventative measures, according to research presented at CROI 2016.

Researchers, including Keri N. Althoff, PhD, MPH, assistant professor in the department of epidemiology, Johns Hopkins Bloomberg School of Public Health, analyzed data on adults with HIV and validated end-stage liver disease (ESLD) between January 2000 and December 2009.

Keri N. Althoff

“Our objective was to estimate the population attributable fractions for traditional and HIV-related modifiable risk factors, interpreted as the proportion of ESLD that could be avoided in HIV-infected adults if all were unexposed to the modifiable risk factor of interest,” Althoff told Healio.com/Hepatology.

Modifiable risk factors for ESLD examined included HCV, hepatitis B virus infection, cigarette smoking, at-risk alcohol use (greater than 3 drinks per day or greater than 7 drinks per week for women, and greater than 4 drinks per day or greater than 14 drinks per week for men), low CD4 (less than 200 cells/mm³), unsuppressed HIV viral load (HIV RNA greater than 400 copies/mL) and a past clinical AIDS diagnosis. Alcohol use information was available on 36% of the 34,044 participants, on which they conducted sub-group analyses.

Over a median follow-up of 3.1 years, 34,044 adults contributed 134,315 person-years and 387 validated diagnoses of ESLD. Patients who developed ESLD tended to be older and were more likely to be male and white compared with patients who did not develop ESLD.

In addition, patients with ESLD were more likely to have HCV, HBV, engage in at-risk alcohol use, smoke, have a low CD4 count and had a prior AIDS-defining illness compared with patients who did not develop ESLD.

“Preventing HCV and HBV could avoid up to 31% and 16% of ESLD in HIV-infected adults, respectively,” the researchers wrote. “HCV treatment provision with newly available direct-acting agents may have a notable effect on preventing ESLD in HIV-infected patients.”

In the sub-group analysis, the population attributable fractions for at-risk alcohol use was 33%. However, there were no meaningful differences in population attributable fractions estimates for other risk factors, according to the abstract. Avoiding a low CD4 count (less than 200 cells/mm3) could avert 25% of ESLD cases. 

The researchers concluded: “Prevention programs for at-risk alcohol use could avoid up to 33% of ESLD. A quarter of ESLD events may be averted with strong immune function further supporting early and consistent ART use for non-HIV disease prevention.” – by Melinda Stevens

Reference:

Althoff KN, et al. Abstract #150. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: Althoff reports being a member of the medical advisory board for Gilead Sciences.