HIV and Liver Disease

It is my pleasure to introduce this issue of Seminars in Liver Diseases devoted to hepatic complications in HIV-infected individuals. Following the widespread use of triple combination antiretroviral therapy introduced in 1996, liver disease has become a major if not the leading cause of hospitalization and death in HIV-positive individuals in Western countries, replacing classical opportunistic infections associated with advanced immunodeficiency. Now HIV-infected patients on antiretroviral therapy live longer, providing this benefit the opportunity to unmask first liver disease than AIDS in patients coinfected with HIV and hepatitis viruses.

Besides coinfection with any of the hepatitis viruses, liver disease in HIV may result from the hepatotoxicity of medications (including antiretroviral agents) and from steatohepatitis associated with metabolic abnormalities. These causes are addressed separately by invited international experts, who highlight the prevalence of these conditions, the best ways to prevent them, and how to manage already infected individuals.

Two articles address special situations. One focusses on the status of viral hepatitis in resource-poor regions, where most HIV-infected persons are living, viral hepatitis coinfections are common, and the implementation of any antiviral therapy is a huge challenge. The second article presents the pros and cons of liver transplantation for managing end-stage liver disease in HIV-positive persons, highlighting the good results already obtained for hepatitis B and hepatitis delta, and providing hope for HCV based on the arrival of new direct-acting antivirals.