HIV and the liver

HIV-related liver dysfunction can be categorized as three types: that related to the immunocompromised state, co-infection with hepatitis viruses or drug-related adverse events. A low CD4 lymphocyte count is linked to biliary tract disease caused by cytomegalovirus and cryptosporidia, granulomatous hepatitis with infections such as tuberculosis and leishmaniasis, and malignant hepatic infiltration including lymphoma, Kaposi sarcoma and hepatoma. HIV patients are more likely to develop chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, the prognosis is worse and treatment less effective than in HIV-uninfected individuals. Drug-related liver dysfunction is also common in HIV infection and includes hepatocellular dysfunction with antiretrovirals such as nevirapine, hyperbilirubinaemia due to atazanavir and hepatic steatosis due to stavudine. HAART has made HIV-related liver disease more amenable to therapy. Chronic HBV infection can be treated with a range of drugs including pegylated interferon, adefovir, telbivudine and the antiretrovirals tenofovir, lamivudine and emtricitabine. Acute and chronic hepatitis C will respond, to a variable degree, to pegylated interferon and ribavirin. Fifty per cent of patients with chronic HCV due to genotypes 2 or 3 and 30% with genotypes 1 or 4 will respond to treatment. Liver transplantation can be offered when needed.