Helen Kovari1, Rainer Weber. 1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland. helen.kovari@usz.ch
Abstract
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.
PURPOSE OF REVIEW: Liver disease is a major cause of morbidity and mortality in HIV-infectedpersons. 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-coinfectedpatients, 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-monoinfectedpatients. 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-monoinfectedpatients. Future research should focus on long-term ART-related hepatotoxicity.
Authors: Helen Kovari; Caroline A Sabin; Bruno Ledergerber; Lene Ryom; Signe W Worm; Colette Smith; Andrew Phillips; Peter Reiss; Eric Fontas; Kathy Petoumenos; Stéphane De Wit; Philippe Morlat; Jens D Lundgren; Rainer Weber Journal: Clin Infect Dis Date: 2012-10-22 Impact factor: 9.079
Authors: Jim Young; Vincent Lo Re; H Nina Kim; Timothy R Sterling; Keri N Althoff; Kelly A Gebo; M John Gill; Michael A Horberg; Angel M Mayor; Richard D Moore; Michael J Silverberg; Marina B Klein Journal: Pharmacoepidemiol Drug Saf Date: 2021-11-23 Impact factor: 2.732
Authors: Helen Kovari; Caroline A Sabin; Bruno Ledergerber; Lene Ryom; Peter Reiss; Matthew Law; Christian Pradier; Francois Dabis; Antonella d'Arminio Monforte; Colette Smith; Stephane de Wit; Ole Kirk; Jens D Lundgren; Rainer Weber Journal: Open Forum Infect Dis Date: 2016-01-21 Impact factor: 3.835