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Liver disease: the effects of HIV and antiretroviral therapy and the implications for early antiretroviral therapy initiation

Vogel, Martin; Rockstroh, Jürgen K

Current Opinion in HIV and AIDS: May 2009 - Volume 4 - Issue 3 - p 171–175
doi: 10.1097/COH.0b013e328329c602
Early treatment: Edited by Sean Emery and Andrew Phillips

Purpose of review With the advent of highly active antiretroviral therapy (HAART), end-stage liver disease has emerged as a major cause of death in HIV and hepatitis-coinfected patients. With the recent change of guidelines recommending early HAART for the treatment of HIV in hepatitis B or C-coinfected patients, the question arises how these recommendations are substantiated by existing data. In the following review, we discuss current data on the effects of HAART in the context of concurrent hepatitis B and C infection.

Recent findings Virologically successful HAART slows the progression of liver fibrosis and downregulates liver inflammation in hepatitis-coinfected patients. Indeed, cohort studies demonstrate a reduction in liver disease-related death events in HAART-treated patients. Moreover, the rate of immune reconstitution under HAART has been shown to determine the risk for future hepatic decompensation.

Summary Early HAART clearly proves to be beneficial for hepatitis-coinfected patients, and concerns on an increased risk for drug-related liver injury should not be a reason to withhold HAART.

Department of Internal Medicine I, Bonn University, Bonn, Germany

Correspondence to Professor Dr Jürgen Rockstroh, Immunologische Ambulanz, Medizinische Klinik und Poliklinik I, Sigmund-Freud-Str. 25, 53105 Bonn, Germany Tel: +49 228 287 16558; fax: +49 228 287 15034; e-mail: juergen.rockstroh@ukb.uni-bonn.de

© 2009 Lippincott Williams & Wilkins, Inc.