Human immunodeficiency virus and liver disease forum 2012
Potential conflict of interest: Dr. Chung consults for Enanta and Idenix and received grants from Gilead, Massachusetts Biologics, Merck, and Vertex. Dr. Thomas consults and received grants from Gilead and Merck. He consults for Janssen. Dr. Sherman consults and received grants from Roche/Genentech. He consults for Janssen and Kadmon and received grants from Bristol-Myers Squibb and Merck. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government.
Funding for this conference was made possible, in part, by the National Institutes of Health (under award no. R13AI071925 from the National Institute of Allergy and Infectious Diseases), with cofunding from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. This work was supported by educational grants from Merck, Genentech, Bristol-Myers Squibb, Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc. administered by Janssen Services, LLC, and Kadmon Pharmaceuticals, LLC.
In the United States, more than 1.1 million individuals are infected with the human immunodeficiency virus (HIV). These patients exhibit a high frequency of coinfections with other hepatotropic viruses and ongoing fibrosis, leading to cirrhosis and liver-related mortality. Etiologies of liver disease include viral hepatitis coinfections, drug-related hepatotoxicity, fatty liver disease, and direct and indirect effects from HIV infection, including increased bacterial translocation, immune activation, and presence of soluble proteins, that modulate the hepatic cytokine environment. New treatments for hepatitis C virus (HCV) using direct-acting agents appear viable, though issues related to intrinsic toxicities and drug-drug interactions remain. Recent research suggests that acute HCV infection, unrecognized hepatitis D infection, and hepatitis E may all represent emergent areas of concern. Antiretroviral agents, including those used in recent years, may represent risk factors for hepatic injury and portal hypertension. Key issues in the future include systematic implementation of liver disease management and new treatment in HIV-infected populations with concomitant injection drug use, alcohol use, and low socioeconomic status. (Hepatology 2014;58:307–317)