Liver fibrosis in HIV: which role does HIV itself, long-term drug toxicities and metabolic changes play?
OBJECTIVE
Liver disease is one of the main causes of non-AIDS death in HIV-infected individuals from Europe and North America and has been attributed mainly to coinfection with hepatotropic viruses. However, HIV-induced inflammation as well as long-term antiretroviral drug toxicity may also contribute to clinical relevant liver disease. Therefore, a better understanding of liver disease beyond viral hepatitis coinfection is urgently needed in HIV-infected individuals.


RESULTS
Cross-sectional fibroscan studies in HIV-infected patient populations have reported unexpectedly high rates of advance fibrosis in HIV-infected patients even without underlying viral hepatitis or alcohol abuse suggesting that HIV itself may contribute independently to liver disease. Finally, HIV therapy itself either through direct hepatotoxicity or long-term metabolic changes, such as dyslipidemia and/or insulin resistance, may additionally cause liver damage in life long treatment.


CONCLUSIONS
Therefore, aging of the liver in HIV may play a much more pivotal role in the future considering age-related effects, coinfection with hepatotropic viruses and the toxicity of long-term antiviral treatment. Thus, adequate monitoring of liver disease and development of management algorithms are clearly needed to optimize outcome and care of the aging liver in an HIV-infected individual.
aDepartment of Medicine I, University Hospital Bonn bGerman Centre for Infection Research (DZIF), partner site Bonn-Cologne, Bonn cDepartment of Medicine, University Hospital Hannover dGerman Centre for Infection Research (DZIF), partner site Hannover, Hannover, Germany.
Jürgen K
JK
Rockstroh
Raphael
R
Mohr
Georg
G
Behrens
Ulrich
U
Spengler
D000375:Aging; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology
D019380:Anti-HIV Agents