End-stage liver disease in HIV disease.

Liver disease is the most common non-AIDS-related cause of mortality in HIV-infected patients. HIV-infected patients with chronic liver disease progress more rapidly to cirrhosis, and those with hepatitis B virus or hepatitis C virus coinfection progress more rapidly from decompensation to death and are at increased risk of death from end-stage liver disease. With improvements in health associated with antiretroviral therapy, liver transplantation is increasingly an option in HIV-infected patients with end-stage liver disease. Elements of management of decompensated liver disease, including staging, treatment of variceal hemorrhage and ascites, and considerations in transplantation in the HIV-infected patient are discussed. This article summarizes a presentation made by Marion G. Peters, MD, at the International AIDS Society-USA continuing medical education program held in Chicago in May 2009. The original presentation is available as a Webcast at www.iasusa.org.