ORIGINALES BREVES Changes in liver-related hospital admissions and hospital mortality among HIV-infected patients (1998 to 2005) José del Valle a,b , Juan Macías a,b , José Antonio Mira a,b , José Ángel García-García b , Jesús Gómez-Mateos a and Juan Antonio Pineda a a Unidad de Enfermedades Infecciosas. b Servicio de Medicina Interna. Hospital Universitario de Valme. Seville. Spain. Introduction Highly active antiretroviral therapy (HAART) has changed the natural history of human immunodeficiency virus (HIV) infection in patients who have access to it 1 . The decrease in hospital admissions and deaths due to ac- quired immunodeficiency syndrome (AIDS) in this popu- lation has paralleled an increase in the number of hospi- talizations and deaths due to other causes 2 . Thus, the importance of liver-related diseases (LRD) as a cause of hospital admission and death has increased in HIV-in- fected patients 3,4 . In recent years, however, increasingly more patients are being effectively treated for hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. In addition, HAART has been found to slow down the progression of liver fibrosis and reduce liver-related mortality in HIV/HCV-coinfected patients 5,6 . Based on these facts, we hypothesized that liver-related morbidity and mortality in HIV-infected patients has declined in the last few years. Methods HIV-infected patients hospitalized from January 1998 to December 2005 were retrospectively analyzed in this serial cross-sectional study. All the discharge and the in-hospital death reports in our in- stitution are codified using the International Classification of Dis- eases, 9 th edition (ICD-9). The patients analyzed met the following criteria: 1) 18 years old or older; 2) ICD-9 codes corresponding to HIV infection (042 and V08) at discharge or on the in-hospital death report; 3) ICD-9 codes referring to LRD at discharge or on the in-hospital death report (chronic liver disease, cirrhosis, chronic and acute HBV infection, chronic HCV infection, chronic HCV with hepatic coma, non-alco- holic liver cirrhosis, gastrointestinal bleeding, esophageal varices with bleeding, ascites, pharmacological liver toxicity, alcoholic liver disease, hepatic encephalopathy, congestive gastropathy in portal hypertension, hepatorenal syndrome, hepatocellular carcinoma, portal vein thrombosis, acute liver failure and spontaneous bacteri- al peritonitis: 070.9, 070.30, 070.32, 070.44, 070.54, 155.0, 452, 456.20, 537.89, 567.9, 571.2, 571.5, 571.9, 572.2, 572.4, 573.3, 573.8, 578.9 and 789.5). Only one admission per patient and year was computed to avoid repeated inclusion of the same patient in one calendar year. Data were analyzed in 4 periods of 2 years. The statistical analysis was per- formed using the chi-square test for linear trends, and a chi-square test was applied to compare mortality among biennia. Associations with a P value of  0.05 were considered significant. Statistical analy- ses were carried out using Stat-Cal (EpiInfo 3.3.2, Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and SPSS 11 (SPSS Inc., Chicago, Illinois, USA). Liver-related disease has increased as a cause of hospitalization and in-hospital death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART). Better clinical management of these diseases may contribute to decreasing their incidence. Admissions due to liver-related disease in HIV-infected patients in our institution increased from 2.9% in 1998-1999 to 11.3% in 2004-2005 (P  0.001). In-hospital deaths due to this cause increased from 2.7% in 1998-1999 to 26% in 2002-2003 (P  0.02), with a subsequent decrease to 22% in 2004-2005. Hospitalization of HIV-infected patients for liver-related disease continues to increase, whereas the rate of in-hospital deaths from this cause appears to have changed since 2003. Key words: HIV infections. Liver disease. HAART. Morbidity. Mortality. Evolución de los ingresos y la mortalidad por hepatopatía en pacientes infectados por el VIH entre 1998 y 2005 La hepatopatía ha aumentado como causa de ingreso y muerte intrahospitalaria en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) tras la aparición de la terapia antirretroviral de gran actividad (TARGA). Un mejor manejo clínico de la hepatopatía podría ayudar a disminuir su incidencia. En nuestro centro, los ingresos por hepatopatía aumentaron del 2,9% en 1998-1999 al 11,3% en 2004-2005 (p  0,001). Las muertes intrahospitalarias debidas a hepatopatía aumentaron del 2,7% en 1998-1999 al 26% en el período 2002-2003 (p  0,02) y disminuyeron al 22% en 2004-2005. Si bien el número de ingresos por hepatopatía en pacientes infectados por el VIH todavía sigue aumentando, parece que la mortalidad intrahospitalaria ha sufrido un cambio desde 2003. Palabras clave: Infección por VIH. Hepatopatía. TARGA. Morbilidad. Mortalidad. Correspondence: Dr. J. Macías. Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna. Hospital Universitario de Valme. Avda. de Bellavista, s/n. 41014 Sevilla. Spain. E-mail: jmacias@cica.es Manuscript received on July 6, 2007; accepted for publication on January 22, 2008. 500 Enferm Infecc Microbiol Clin 2008;26(8):500-1 Document downloaded from http://www.elsevier.es, day 19/06/2017. This copy is for personal use. 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