Management of end-stage liver disease in HIV-infected patients

Abstract

This review provides information on the natural history of end-stage liver disease in HIV/hepatitis C virus-coinfected patients from diagnosis to liver transplantation or death and summarizes recent developments in the epidemiology, management, and prognosis of end-stage liver disease and orthotopic liver transplantation in this population compared with the HIV-negative population. Many studies have described epidemiological aspects, including the increasing incidence of end-stage liver disease, as a cause of non-AIDS-related death in the co-infected population in developed countries, whereas other reports have focused on the clinical presentation and prognosis of end-stage liver disease in this specific clinical setting. The medical management of end-stage liver disease should be the same as for the HIV-negative population, and orthotopic liver transplantation is the only therapeutic option for HIV-infected patients who are eligible for this procedure. End-stage liver disease is becoming a major issue in the HIV/HCV-coinfected population because of its increasing frequency, especially now the prognosis of HIV infection has improved with combined antiretroviral therapy. Medical management is essential and should be considered a bridge to orthotopic liver transplantation. Nevertheless, many issues remain unclear and must be examined in further studies.