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HIV, viral hepatitis patients should avoid alcohol, maintain CD4 counts. (Haart Helps Those With Coinfection).

BOSTON -- A heavy alcohol intake is associated with increased liver-related mortality in patients coinfected with HIV and viral hepatitis, Dr. Maurizio Bonacini reported at the annual meeting of the American Association for the Study of Liver Disease.

In a prospective study of 473 patients with HIV infection, with or without viral hepatitis coinfection, death due to liver disease was 12 times more likely in those with CD4 blood counts below 200 cells/[micro]L, average daily alcohol intake greater than 50 g, and an evaluation for HIV prior to 1996, compared with patients who had none of those factors.

"Patients with HIV and hepatitis B or C coinfection should keep their CD4 counts as high as possible and avoid alcohol like the plague," said Dr. Bonacini of California Pacific Medical Center, San Francisco.

The patients in the study, who were followed for a total of 8,300 patient-months, were seen at the University of Southern California, Los Angeles, HIV Clinic. Mortality data were obtained via the Los Angeles County HIV Epidemiology Unit.

All-cause mortality was higher in the 154 patients with HIV infection and no viral hepatitis than in the 233 patients with HIV and hepatitis C (HCV) or the 73 with HIV and hepatitis B (HBV). But when the data were adjusted for CD4 counts, coinfection with HBV or HCV did not influence liver-related mortality. This was somewhat surprising, he said, because some studies have suggested that HIV accelerates the progression of HCV infection.

"Hepatitis C is known to follow a more aggressive course in some posttransplant and HIV/HCV coinfected patients," Dr. Bonacini noted. "The latter group develops cirrhosis more frequently than HCV monoinfected patients, particularly at the later stages of HIV disease, and liver disease now accounts for a large percentage of total mortality in patients with HIV infection."

In his study, liver mortality was significantly higher in the subgroup of 320 patients with HCV or HBV who had an initial CD4 count below 200 cells/[micro]L or an average lifetime alcohol use above 50 g/day, compared with those with higher CD4 counts and lower alcohol use. Liver mortality also was significantly higher in patients first evaluated for HIV prior to the 1996 introduction of highly active anti-retroviral therapy (HAART) vs. those seen in 1996 or later, when such therapy was available.

The findings show that HAART saves lives for people with HIV and for people with HIV and viral hepatitis coinfection, Dr. Bonacini concluded.
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Author:Mulcahy, Nicholas
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Feb 1, 2003
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