Liver Disease in the HIV–Infected Individual

Abstract

Since the advent of effective antiretroviral therapy (ART) for human immunodeficiency virus-1 (HIV), there has been a substantial decrease in deaths related to acquired immunodeficiency syndrome (AIDS). However, in the ART-era liver disease is now the most common non-AIDS related cause of death among HIV-infected patients, accounting for 14-18% of all deaths in this population and almost half of deaths among hospitalized HIV-infected patients. Just as the burden of non-AIDS morbidity and mortality has changed in the ART-era, the types of liver disease the clinician is likely to encounter among these patients have changed as well. This review will discuss the causes of liver disease in the HIV-infected population in the ART-era, including chronic hepatitis C virus, chronic hepatitis B virus, medication-related hepatotoxicity, alcohol abuse, nonalcoholic fatty liver disease, and AIDS-related liver diseases. Keywords human immunodeficiency virus; liver disease; hepatitis C virus; hepatitis B virusManaging liver disease is an increasingly important component to the care of individuals infected with human immunodeficiency virus-1 (HIV). Since the advent of effective antiretroviral therapy (ART) for HIV, there has been a substantial decrease in deaths related to acquired immunodeficiency syndrome (AIDS) [1][2][3] . However, liver disease has emerged as the most common non-AIDS related cause of death among HIV-infected patients, accounting for 14-18% of all deaths [3,4] In some series, nearly half of deaths among hospitalized HIV-infected patients in the ART-era have been attributed to liver disease [5,6] .Just as the burden of non-AIDS morbidity and mortality has changed in the ART-era, the types of liver disease the clinician is likely to encounter among these patients have also changed [7]. Prior to ART, the most common causes of liver dysfunction in HIV-infected patients were opportunistic infections, including cytomegalovirus (CMV) and mycobacterium infections, and AIDS-related neoplasms such as lymphoma and Kaposi's © 2010 The American Gastroenterological Association. Published by Elsevier Inc. All rights reserved. jcohen@jhmi.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclosures:The authors do not have any potential conflicts to disclose.Writing Assistance: Both authors, JCP and CLT, were involved in writing this manuscript. No other individuals provided writing assistance. NIH Public Access Author ManuscriptClin Gastroenterol Hepatol. Author manuscript; available in PMC 2011 December 1. [8,9] . Since the ART-era, however, the spectrum of liver disease...

Intentional Non-Adherence to Medications among HIV Positive Alcohol Drinkers: Prospective Study of Interactive Toxicity Beliefs

“…Nevertheless, the potential for adverse reactions exist in response to mixing ART with other drugs. 9,10 In addition, the metabolic pathways involved in absorbing some classes of ART are shared with Analyses control for AUDIT score and use of other drugs some classes of psychoactive drugs, such as amphetamine. In some cases, psychotropic medications can interfere with the absorption of ART, reducing antiviral potency and therefore effectiveness.…”

“…7,8 Although alcohol use can contribute to liver damage in people coinfected with HIV and Hepatitis C virus, 5 there is no evidence that the hepatotoxicity of alcohol is amplified in combination with ART. [9][10][11] Beliefs that mixing medications with alcohol results in a toxic blend (i.e., alcohol-ART interactive toxicity beliefs) are associated with poor treatment adherence, even to a greater extent than alcohol use itself. 8 The current study was conducted to further examine alcohol-ART interactive toxicity beliefs and behaviors among drinkers who are currently treated with ART.…”

Retrospective Analysis of Causes of Death in Hiv Infected Patients in Imphal, Manipur, North Eastern Part of India

“…7 Hepatic causes constituting 27% of deaths making it second most common system to cause death in HIV patients; this observation is supported by a study in United States of America. 8 Central nervous system involvement excluding TBM constitute 14%, other opportunistic infections were 7%, Haematological causes were 4%, Gastrointestinal 4%, Renal causes were 3%, Cardiovascular 2%, other systemic infections 2% and Miscellaneous causes of death were 2%. These findings were supported by various studies published in other countries 9 and other parts of India.…”

The Risk of Hepatotoxicity Associated with HAART/Anti-Tb Co-Treatment: A Case Control Study in a Central Ethiopian Referral Hospital

“…The most important risk factors for hepatotoxicity in individuals receiving TB treatment are: Age >35 years; being a child; perhaps a female gender; Hepatitis B surface Antigen (HBsAg) positive; use of alcohol; slow acetylator status; extensive TB disease; increase in baseline ALT; malnutrition; Hepatitis C Virus (HCV) co infection; and HIV co-infection [6]. Other cause includes co-administered medications like cotrimoxazole and antifungals [7][8][9].…”