title: Influence of antiretroviral therapy on liver disease.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland. helen.kovari@usz.ch
authors.forename: Helen
authors.initials: H
authors.lastname: Kovari
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology*; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology*; D006801:Humans
chemical_list: D019380:Anti-HIV Agents