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Aumento de la carga de enfermedad hepática en pacientes con infección por VIH
Deepak Joshi1, John O'Grady, Doug Dieterich
1Institute of Liver Studies, King's College Hospital, London, UK.
Lancet (London, England)
|April 5, 2011
Resumen
El tratamiento efectivo del VIH transforma el VIH en una condición crónica, pero aumenta los riesgos de enfermedad hepática por coinfecciones virales y enfermedad hepática grasa no alcohólica. Las estrategias de gestión son cruciales para mejorar los resultados de los pacientes.
Área de la Ciencia:
- Hepatología Hepatología.
- Enfermedades infecciosas Enfermedades infecciosas.
- Inmunología Inmunología.
Sus antecedentes:
- La terapia antirretroviral combinada (TARC) ha convertido la infección por el virus de la inmunodeficiencia humana (VIH) en una enfermedad crónica manejable.
- Mientras que la cART reduce la mortalidad relacionada con el SIDA, la carga de la enfermedad hepática ha aumentado debido a las coinfecciones virales (hepatitis B y C), la enfermedad hepática grasa no alcohólica (NAFLD), la lesión hepática inducida por medicamentos (DILI) y el carcinoma hepatocelular (HCC).
Objetivo del estudio:
- Proporcionar una visión global de las causas primarias y la patogénesis de la enfermedad hepática en personas con infección por VIH.
- Discutir las estrategias de tratamiento actuales y emergentes para la enfermedad hepática en el contexto de la gestión del VIH, incluida la función del trasplante de hígado.
Principales métodos:
- Revisión de la literatura y síntesis de la investigación existente sobre el VIH y las enfermedades del hígado.
- Análisis de datos epidemiológicos y estudios clínicos relativos a las comorbilidades hepáticas en individuos infectados por el VIH.
Principales resultados:
- La coinfección del VIH con los virus de la hepatitis B y C contribuye significativamente a la morbilidad y mortalidad hepática.
- La enfermedad hepática grasa no alcohólica y la hepatotoxicidad inducida por medicamentos se reconocen cada vez más como los principales contribuyentes a la enfermedad hepática en la población VIH-positiva.
- El desarrollo del carcinoma hepatocelular es una preocupación significativa, que requiere una detección y un manejo proactivos.
Conclusiones:
- Las estrategias de manejo integrado que abordan la hepatitis viral, NAFLD, DILI y HCC son esenciales para mitigar la enfermedad hepática en pacientes infectados por el VIH.
- El papel del trasplante de hígado está evolucionando y puede ofrecer una opción viable para seleccionar pacientes con enfermedad hepática en etapa terminal debido a complicaciones relacionadas con el VIH.
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