Adriana Cervo1,2, Mohamed Shengir3, Keyur Patel4, Giada Sebastiani5. 1. Division of Infectious Diseases, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada. 2. Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy. 3. Division of Experimental Medicine, McGill University, Montreal, Canada. 4. Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, Canada. 5. Division of Gastroenterology and Hepatology, Chronic Viral Illness Service Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd. Décarie, Montreal, QC H4A 3J1, Canada. giada.sebastiani@mcgill.ca.
Abstract
PURPOSE OF REVIEW: Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. RECENT FINDINGS: Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH.
PURPOSE OF REVIEW: Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. RECENT FINDINGS: Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH.
Authors: Bridget S Fisher; Katherine A Fancher; Andrew T Gustin; Cole Fisher; Matthew P Wood; Michael Gale; Benjamin J Burwitz; Jeremy Smedley; Nichole R Klatt; Nina Derby; Donald L Sodora Journal: Front Immunol Date: 2022-01-10 Impact factor: 8.786
Authors: Giada Sebastiani; Jovana Milic; Adriana Cervo; Sahar Saeed; Thomas Krahn; Dana Kablawi; Al Shaima Al Hinai; Bertrand Lebouché; Philip Wong; Marc Deschenes; Claudia Gioè; Antonio Cascio; Giovanni Mazzola; Giovanni Guaraldi Journal: J Pers Med Date: 2022-02-15