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

Rockstroh, Jürgen K.; Mohr, Raphael; Behrens, Georg; Spengler, Ulrich

Current Opinion in HIV and AIDS: July 2014 - Volume 9 - Issue 4 - p 365–370
doi: 10.1097/COH.0000000000000064
HIV AND AGING: Edited by Amy C. Justice and Julian Falutz
Editor's Choice

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.

aDepartment of Medicine I, University Hospital Bonn

bGerman Centre for Infection Research (DZIF), partner site Bonn-Cologne, Bonn

cDepartment of Medicine, University Hospital Hannover

dGerman Centre for Infection Research (DZIF), partner site Hannover, Hannover, Germany

Correspondence to Professor Jürgen K. Rockstroh, Department of Medicine I, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Tel: +49 228 287 16558; fax: +49 228 287 15034; e-mail:

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