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Management of hepatic complications in HIV-infected persons

Mark S Sulkowski1

  • 1Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA. msulkowski@jhmi.edu

The Journal of Infectious Diseases
|June 14, 2008
PubMed

Insights

Effective antiretroviral therapy (ART) is crucial for managing liver disease in HIV patients. While co-infection with hepatitis B or C presents challenges, ART is generally safe and can benefit liver health.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Immunology

Background:

  • Liver disease is a leading cause of death in individuals with human immunodeficiency virus (HIV) infection, particularly due to chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) co-infection.
  • Hepatitis C virus (HCV) transmission may occur sexually among HIV-infected men who have sex with men, adding complexity to management.
  • Managing viral hepatitis in HIV-infected individuals requires balancing therapeutic benefits against potential adverse effects like hepatotoxicity, viral resistance, and hepatitis flares.

Purpose of the Study:

  • To review the impact of liver disease on mortality in patients with HIV infection.
  • To discuss the management strategies for HBV and HCV co-infections in the context of effective antiretroviral therapy (ART).
  • To evaluate the safety and potential benefits of ART in HIV-infected individuals with viral hepatitis.

Main Methods:

  • Literature review of studies on liver disease in HIV-infected populations.
  • Analysis of the role of HBV and HCV in HIV-related mortality.
  • Examination of treatment considerations for viral hepatitis co-infections in patients receiving ART.

Main Results:

  • Antiretroviral agents like lamivudine, emtricitabine, tenofovir, and entecavir show activity against HBV.
  • Despite potential for antiretroviral-associated hepatotoxicity, ART is typically safe for patients with viral hepatitis co-infection.
  • In certain cases, ART for HIV infection can positively impact liver health.

Conclusions:

  • Liver disease remains a significant cause of mortality in HIV-infected individuals, primarily due to HBV/HCV co-infection.
  • Careful management is essential, considering treatment benefits and risks for both HCV and HBV in HIV patients.
  • Antiretroviral therapy is generally safe and can be beneficial for the liver in co-infected patients.

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