Liver disease: the effects of HIV and antiretroviral therapy and the implications for early antiretroviral therapy initiation.
OBJECTIVE
With the advent of highly active antiretroviral therapy (HAART), end-stage liver disease has emerged as a major cause of death in HIV and hepatitis-coinfected patients. With the recent change of guidelines recommending early HAART for the treatment of HIV in hepatitis B or C-coinfected patients, the question arises how these recommendations are substantiated by existing data. In the following review, we discuss current data on the effects of HAART in the context of concurrent hepatitis B and C infection.


RESULTS
Virologically successful HAART slows the progression of liver fibrosis and downregulates liver inflammation in hepatitis-coinfected patients. Indeed, cohort studies demonstrate a reduction in liver disease-related death events in HAART-treated patients. Moreover, the rate of immune reconstitution under HAART has been shown to determine the risk for future hepatic decompensation.


CONCLUSIONS
Early HAART clearly proves to be beneficial for hepatitis-coinfected patients, and concerns on an increased risk for drug-related liver injury should not be a reason to withhold HAART.
Vogel
Martin
M
Department of Internal Medicine I, Bonn University, Bonn, Germany.
Rockstroh
Jürgen K
JK
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents