Highly active antiretroviral therapy has improved prognosis of HIV infection and substantially reduced the incidence of opportunistic diseases. However, hepatitis viruses and HIV share the same routes of transmission. Thus, chronic viral hepatitis is found frequently in HIV-infected patients. Antiretroviral drugs do not directly interact with the hepatitis C virus (HCV), so that end-stage liver disease (ESLD) in HCV/HIV co-infected patients has become a leading clinical problem in many co-infected patients.
This review summarizes up-to-date guidelines in the management of ESLD and specifically addresses issues of cirrhosis in HCV/HIV co-infection. The most recent advances in the treatment of typical complication of ESLD such as esophageal varices (updated guidelines), variceal hemorrhage (early use of transjugular intrahepatic portosystemic shunt), ascites (updated guidelines), hepatorenal syndrome (vasopressor therapy, deleterious effects of beta-blockers), spontaneous bacterial peritonitis (primary prophylaxis) and hepatic encephalopathy (use of rifaximin) are discussed. This review also provides a basic outline on liver transplantation in HCV/HIV co-infected patients.
Thus, physicians involved in the management of ESLD in HCV/HIV co-infected patients will find a comprehensive overview over current treatment strategies in ESLD of HIV-positive patients as well as a valuable collection of pivotal references on the most recent advances in the treatment of ESLD due to HCV/HIV co-infection.
Department of Internal Medicine 1, University of Bonn, Bonn, Germany
Correspondence to Professor Dr Ulrich Spengler, Department of Internal Medicine 1, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany E-mail: Spengler@uni-bonn.de