Will antiretroviral therapy reduce HIV-related liver risk?

Abstract

With the introduction of combined antiretroviral therapy (cART) and consequent reduction in the incidence of AIDS-related mortality, there has been a relative increase in the importance of non-AIDS-related conditions such as liver disease. This article reviews the positive and potential negative impact of cART on liver-related morbidity and mortality. Though non-AIDS-related mortality, and particular, liver disease now accounts for a larger proportion of deaths in HIV-positive individuals than we have previously seen, liver-related mortality is decreasing. This is likely to be as a result of both the use of cART and improved patient management. Most liver-related mortality is related with viral hepatitis, the outcomes of which are improved with cART. Serious hepatotoxicity and death from cART is rare and mainly attributable to older antiretroviral drugs. This review shows that outcomes are improving, but more work is required to improve liver-related morbidity and mortality further and determine any other longer-term positive and negative effects of cART.