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Current Opinion in HIV & AIDS:
doi: 10.1097/COH.0000000000000064
HIV AND AGING: Edited by Amy C. Justice and Julian Falutz

Liver fibrosis in HIV: which role does HIV itself, long-term drug toxicities and metabolic changes play?

Rockstroh, Jürgen K.a,b; Mohr, Raphaela,b; Behrens, Georgc,d; Spengler, Ulricha,b

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Abstract

Purpose of review: Liver disease is one of the main causes of non-AIDS death in HIV-infected individuals from Europe and North America and has been attributed mainly to coinfection with hepatotropic viruses. However, HIV-induced inflammation as well as long-term antiretroviral drug toxicity may also contribute to clinical relevant liver disease. Therefore, a better understanding of liver disease beyond viral hepatitis coinfection is urgently needed in HIV-infected individuals.

Recent findings: Cross-sectional fibroscan studies in HIV-infected patient populations have reported unexpectedly high rates of advance fibrosis in HIV-infected patients even without underlying viral hepatitis or alcohol abuse suggesting that HIV itself may contribute independently to liver disease. Finally, HIV therapy itself either through direct hepatotoxicity or long-term metabolic changes, such as dyslipidemia and/or insulin resistance, may additionally cause liver damage in life long treatment.

Summary: Therefore, aging of the liver in HIV may play a much more pivotal role in the future considering age-related effects, coinfection with hepatotropic viruses and the toxicity of long-term antiviral treatment. Thus, adequate monitoring of liver disease and development of management algorithms are clearly needed to optimize outcome and care of the aging liver in an HIV-infected individual.

© 2014 Lippincott Williams & Wilkins, Inc.

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