The Burden of Liver Disease in Human Immunodeficiency Virus-Infected Patients

Department of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milano, Italy.
Seminars in Liver Disease (Impact Factor: 4.95). 05/2012; 32(2):103-13. DOI: 10.1055/s-0032-1316473
Source: PubMed


Introduction of effective combined antiretroviral therapy has made human immunodeficiency virus (HIV) infection a chronic illness. Substantial reductions in the number of acquired immunodeficiency syndrome- (AIDS-) related deaths have been accompanied by an increase in liver-related morbidity and mortality. Liver diseases rank in the first three most-common causes of death in HIV-infected persons. Mortality is mainly due to cirrhosis and hepatocellular carcinoma induced by hepatitis C virus and hepatitis B virus coinfection. However, antiretroviral drugs toxicity also plays a role. Nonalcoholic fatty liver disease is a common cause of liver injury as well. Nevertheless, alcohol consumption probably plays a pivotal role. Noncirrhotic portal hypertension, an uncommon condition observed in less than 1% of patients, is increasingly described. Finally, acute hepatitis A virus (HAV) and acute and even chronic hepatitis E virus infection have also been reported as causes of liver damage in HIV. Anti-HAV vaccination is thus recommended in persons at risk living with HIV.

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    • "Since the introduction of combination antiretroviral therapy (cART), liver disease has become a major cause of morbidity and mortality in HIV-infected persons and is currently one of the most frequent causes of non-HIV-related death among HIV-infected persons [3]. Whether HCV has a negative impact on the progression of HIV infection has been extensively debated. "
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    ABSTRACT: In the era of Directly Acting anti HCV Antivirals treatment of hepatitis C is successful in the majority of persons treated. However, treatment of persons with HIV or who inject drugs remains challenging because of special issues: drug–drug interactions with antiretroviral, psychiatric and drug substitution therapies, treatment adherence, impact of treatment on HIV disease course or on risk of bacterial infections. Sofosbuvir induced sustained virologic response in 91% of 23 HIV/HCV coinfected persons treated in combination with ribavirin and pegylated interferon, in 83% of 497 treated in combination with ribavirin and in all 50 patients infected with HCV GT1 treated in combination with ledipasvir and ribavirin. The rates of efficacy in HCV–HIV coinfected were almost the same as those observed in HCV monoinfected suggesting that the efficacy of sofosbuvir is not reduced by HIV coinfection. There are no data on the efficacy of sofosbuvir in injection drugs users. The pangenotypic activity, the high barrier to resistance, the modest potential for drug–drug interactions makes sofosbuvir a reference drug for the treatment of these two special populations.
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    ABSTRACT: Purpose of review: With reductions in AIDS-related mortality, patients with HIV infection are dying and experiencing significant morbidity from end-stage organ disease. However, patients infected with HIV have traditionally been excluded from organ transplantation. Recent advances have had a significant impact on the potential transplant candidacy of these patients. This review will highlight the major issues associated with transplantation in individuals who are infected with HIV. Recent findings: Recently published studies showing promising preliminary outcomes among transplant recipients with HIV infection, suggest that it is not any more justifiable to deny transplantation based solely on HIV-infection status. These studies consistently describe stable HIV disease following liver and kidney transplantation. Furthermore, combined pancreas-kidney, heart, and lung transplantation has been successfully reported, although in a much smaller number of patients. Despite these scientific and policy advances, many healthcare providers and patients remain unaware of ongoing progress in this field. Summary: The experience with organ transplantation in HIV-infected patients is evolving and successful outcomes have been observed when specific criteria are used to select candidates.
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    ABSTRACT: Background: Liver disease is currently one of the leading causes of death in HIV individuals. Hepatic fibrosis largely mediates this effect and infection with hepatitis C virus (HCV) is the most common cause. Few studies have examined so far the predictive value of liver fibrosis staging on mortality and liver decompensation in HIV/HCV-coinfected patients. Methods: A prospective programme of liver fibrosis assessment using transient elastometry has been ongoing at our institution since 2004. Data from all HIV/HCV-coinfected patients who underwent a transient elastometry examination and have at least 18 months of follow-up were selected for the current analysis. Results: A total of 545 HIV/HCV-coinfected patients were examined (mean age 41 years, 71% men, 81% IDUs, mean BMI 23.3 kg/m2, HBsAg+ 4.2%, alcohol abuse 8.4%, mean CD4 cell count 519 cells/μl). The mean follow-up was 70.9 ± 15.7 months. During follow-up, 12 patients (2.2%) died, four of them due to hepatic complications. Liver-related events (ascites, encephalopathy, oesophageal varices or hepatocellular carcinoma) appeared in 53 patients (10%). In the multivariate analysis, baseline liver stiffness was the strongest predictor of liver-related complications [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.08-1.16, P < 0.0001] and of all-cause mortality (OR 1.09, 95% CI 1.01-1.19, P = 0.02). The achievement of sustained virological response following peginterferon/ribavirin therapy during the study period was protective against the development of liver-related events (OR 0.02, 95% CI 0-0.23, P = 0.01). Conclusion: Liver fibrosis staging, as measured by transient elastometry, predicts liver-related complications and all-cause mortality in HIV/HCV-coinfected patients on antiretroviral therapy.
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