Human immunodeficiency virus and liver disease: A comprehensive update

Area of Science:

• Hepatology
• Infectious Diseases
• Immunology

Background:

• Liver disease is a leading cause of illness and death in people with human immunodeficiency virus (HIV) infection.
• Multiple overlapping factors contribute to liver disease in HIV patients, including oxidative stress and immune activation.
• Antiretroviral therapy is crucial for managing HIV and its associated liver conditions.

Purpose of the Study:

• To review the multifaceted nature of liver disease in HIV-infected individuals.
• To highlight current and emerging challenges in managing liver disease in this population.
• To emphasize the role of antiretroviral therapy and co-infection management.

Main Methods:

• Literature review and synthesis of existing research on HIV and liver disease.
• Analysis of underlying mechanisms contributing to liver pathology in HIV.
• Discussion of management strategies and barriers to care.

Main Results:

• Liver disease pathogenesis in HIV involves oxidative stress, stellate cell activation, and immune responses.
• Early and effective antiretroviral therapy is key, alongside treatment of cofactors like viral hepatitis and NAFLD/NASH.
• Barriers to care include delayed recognition, access issues, substance abuse, and psychiatric comorbidities.

Conclusions:

• Comprehensive management of liver disease in HIV requires addressing co-infections, lifestyle factors, and mental health.
• Emerging concerns like hepatitis E and D, and rising liver cancer incidence, necessitate ongoing vigilance.
• Integrated care approaches are essential for improving outcomes in HIV-infected individuals with liver disease.