Human immunodeficiency virus and liver disease: An update

Area of Science:

• Hepatology
• Infectious Diseases
• Immunology

Background:

• Human immunodeficiency virus (HIV) infection impacts millions globally, with liver disease progression being a major cause of mortality.
• While combination antiretroviral therapy has reduced HIV complication deaths, its impact on liver-related mortality is limited.
• Causes of liver disease in HIV-infected individuals are multifactorial, including viral hepatitis, NAFLD/NASH, drug toxicities, and metabolic/genetic disorders, exacerbated by immune activation.

Purpose of the Study:

• To highlight the persistent challenges in managing liver disease in patients with HIV infection.
• To underscore the limited impact of current antiretroviral therapies on liver-related mortality.
• To identify key contributing factors to liver disease in the HIV-infected population.

Main Methods:

• Review of existing literature on HIV and liver disease.
• Analysis of mortality data related to HIV complications and liver disease.
• Identification of common etiologies and interacting factors in HIV-associated liver disease.

Main Results:

• Liver disease remains a leading cause of death in HIV-infected individuals, despite advances in HIV treatment.
• Antiretroviral therapy has not significantly decreased liver-related mortality.
• Multiple factors contribute to liver disease, including viral hepatitis, NAFLD/NASH, drug toxicity, and metabolic disorders, influenced by immune dysregulation.

Conclusions:

• Management of liver disease in HIV-infected patients remains challenging.
• Hepatitis C virus treatment and hepatitis B virus suppression have advanced, but overall liver disease management is complex.
• Limited resources, fragmented care, and high prevalence of substance use and depression complicate patient management.