Journal
CURRENT OPINION IN HIV AND AIDS
Volume 6, Issue 4, Pages 272-277Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/COH.0b013e3283473405
Keywords
antiretroviral therapy; hepatitis virus coinfections; HIV; liver
Categories
Funding
- Abbott
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Gilead Sciences
- GlaxoSmithKline
- Merck Sharp Dome
- Pfizer
- Roche
- TRB Chemedica
- Tibotec
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Purpose of review Liver disease is a major cause of morbidity and mortality in HIV-infected persons. The long-term beneficial versus potentially harmful influence of antiretroviral therapy (ART) on the liver is debated. We review current data on factors contributing to liver disease in HIV-monoinfected as well as in HIV/viral hepatitis-coinfected patients, highlighting the role of ART, HIV itself, immunodeficiency, patient characteristics, and lifestyle risk factors. Recent findings New ART-related clinical syndromes, including noncirrhotic portal hypertension and nonalcoholic fatty liver disease, have emerged, and observational data suggest long-term ART-associated liver injury. Recently, there is increasing evidence that HIV itself and immunosuppression are contributing to liver injury in both HIV-coinfected and HIV-monoinfected patients. In HIV-positive persons, ART attenuates progression of chronic viral hepatitis. Summary Current expert guidelines recommend earlier treatment of HIV infection in persons coinfected with hepatitis B virus and possibly hepatitis C virus. It is unknown whether an earlier start of ART is beneficial for the liver in HIV-monoinfected patients. Future research should focus on long-term ART-related hepatotoxicity.
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