Chronic liver disease (CLD) is a leading cause of morbidity and mortality in HIV-infected individuals. The purposes of this study were to determine the prevalence and etiologies of CLD in an urban HIV-infected population and to identify CLD risk factors. We conducted a retrospective chart review of 799 HIV-infected patients seen at four New Haven health centers from 2002 to 2003. We applied the New Haven County Liver Study definition to identify patients with CLD. 65% were male, 44% were African American, and 23% were of Hispanic ethnicity. The mean age was 45 years. 30% had a history of alcohol abuse. 35% reported injection drug use as their HIV risk factor. Heterosexual contact and men having sex with men (MSM) were reported in 31% and 16% of cases. 50% of patients had a diagnosis of AIDS. 60% percent of patients had CLD. Over 50% of cases of CLD were attributed to chronic hepatitis C (HCV), either alone or with coexisting alcoholic liver disease. Alcoholic liver disease alone, hepatitis B virus (HBV), HAART-induced liver disease, and non-alcoholic liver disease (NAFLD) accounted for smaller percentages. 84% of patients were on HAART, but only 3.6% of patients with positive HCV or HBV serologies were on treatment for CLD. 75% of patients received pneumococcal and influenza vaccines, but only half of eligible patients received hepatitis A and B vaccines. In multivariate analysis, alcohol abuse and positive HCV status were associated with CLD. CLD is prevalent in our population. Preventive care and treatment for CLD are being overlooked in many. Vaccines, treatment for viral hepatitis, and strategies for reducing drug and alcohol abuse are priorities.
| Identifer | oai:union.ndltd.org:YALE_med/oai:ymtdl.med.yale.edu:etd-06282006-135229 |
| Date | 15 November 2006 |
| Creators | Pejavar, Sunanda |
| Contributors | Andre Sofair |
| Publisher | Yale University |
| Source Sets | Yale Medical student MD Thesis |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://ymtdl.med.yale.edu/theses/available/etd-06282006-135229/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Yale School of Medicine or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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