HIV Infection and Hepatic Enzyme Abnormalities: Intricacies of the Pathogenic Mechanisms

[Guest guest]

Clinical Infectious Diseases 2004;38:S65-S72

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0005$15.00

HIV Infection and Hepatic Enzyme Abnormalities: Intricacies of the

Pathogenic Mechanisms

Stanislas Pol, Pascal Lebray, and Anaïs Vallet-Pichard

Unité d'Hépatologie and INSERM U-370, Hôpital Necker, Paris, France

Liver enzyme elevations are common in human immunodeficiency virus

(HIV)infected patients, and their diagnosis or management may be difficult

because of the intricacies of the pathogenic mechanisms involved. These

include hepatotoxicity related to the highly active antiretroviral therapy

(HAART) regimen, idiosyncratic or immunoallergic mechanisms, and direct

cytotoxicity enhanced by an underlying liver disease. Liver enzyme

abnormalities may also reflect hepatitis B (HBV) or hepatitis C (HCV)

infection, which each have their own risks for chronic immune-mediated liver

disease (including hepatitis flare after immune reconstitution) and of

direct cytotoxicity. Finally, other factors may affect liver deterioration,

including alcohol-related liver disease, nonalcoholic steatohepatitis

associated with metabolic syndromes (e.g., hyperlipidemia, diabetes, or

being overweight) that are potentially HAART related, and use of medication

or illicit drugs (e.g., methamphetamine). A better understanding of these

complex interactions, including adjustments of dosages of antiretroviral

drugs, will probably help in the management of HIV-infected patients with

liver enzyme abnormalities.

[Guest guest]

Clinical Infectious Diseases 2004;38:S65-S72

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0005$15.00

HIV Infection and Hepatic Enzyme Abnormalities: Intricacies of the

Pathogenic Mechanisms

Stanislas Pol, Pascal Lebray, and Anaïs Vallet-Pichard

Unité d'Hépatologie and INSERM U-370, Hôpital Necker, Paris, France

Liver enzyme elevations are common in human immunodeficiency virus

(HIV)infected patients, and their diagnosis or management may be difficult

because of the intricacies of the pathogenic mechanisms involved. These

include hepatotoxicity related to the highly active antiretroviral therapy

(HAART) regimen, idiosyncratic or immunoallergic mechanisms, and direct

cytotoxicity enhanced by an underlying liver disease. Liver enzyme

abnormalities may also reflect hepatitis B (HBV) or hepatitis C (HCV)

infection, which each have their own risks for chronic immune-mediated liver

disease (including hepatitis flare after immune reconstitution) and of

direct cytotoxicity. Finally, other factors may affect liver deterioration,

including alcohol-related liver disease, nonalcoholic steatohepatitis

associated with metabolic syndromes (e.g., hyperlipidemia, diabetes, or

being overweight) that are potentially HAART related, and use of medication

or illicit drugs (e.g., methamphetamine). A better understanding of these

complex interactions, including adjustments of dosages of antiretroviral

drugs, will probably help in the management of HIV-infected patients with

liver enzyme abnormalities.

[Guest guest]

Clinical Infectious Diseases 2004;38:S65-S72

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0005$15.00

HIV Infection and Hepatic Enzyme Abnormalities: Intricacies of the

Pathogenic Mechanisms

Stanislas Pol, Pascal Lebray, and Anaïs Vallet-Pichard

Unité d'Hépatologie and INSERM U-370, Hôpital Necker, Paris, France

Liver enzyme elevations are common in human immunodeficiency virus

(HIV)infected patients, and their diagnosis or management may be difficult

because of the intricacies of the pathogenic mechanisms involved. These

include hepatotoxicity related to the highly active antiretroviral therapy

(HAART) regimen, idiosyncratic or immunoallergic mechanisms, and direct

cytotoxicity enhanced by an underlying liver disease. Liver enzyme

abnormalities may also reflect hepatitis B (HBV) or hepatitis C (HCV)

infection, which each have their own risks for chronic immune-mediated liver

disease (including hepatitis flare after immune reconstitution) and of

direct cytotoxicity. Finally, other factors may affect liver deterioration,

including alcohol-related liver disease, nonalcoholic steatohepatitis

associated with metabolic syndromes (e.g., hyperlipidemia, diabetes, or

being overweight) that are potentially HAART related, and use of medication

or illicit drugs (e.g., methamphetamine). A better understanding of these

complex interactions, including adjustments of dosages of antiretroviral

drugs, will probably help in the management of HIV-infected patients with

liver enzyme abnormalities.

[Guest guest]

Clinical Infectious Diseases 2004;38:S65-S72

© 2004 by the Infectious Diseases Society of America. All rights reserved.

1058-4838/2004/3805S2-0005$15.00

HIV Infection and Hepatic Enzyme Abnormalities: Intricacies of the

Pathogenic Mechanisms

Stanislas Pol, Pascal Lebray, and Anaïs Vallet-Pichard

Unité d'Hépatologie and INSERM U-370, Hôpital Necker, Paris, France

Liver enzyme elevations are common in human immunodeficiency virus

(HIV)infected patients, and their diagnosis or management may be difficult

because of the intricacies of the pathogenic mechanisms involved. These

include hepatotoxicity related to the highly active antiretroviral therapy

(HAART) regimen, idiosyncratic or immunoallergic mechanisms, and direct

cytotoxicity enhanced by an underlying liver disease. Liver enzyme

abnormalities may also reflect hepatitis B (HBV) or hepatitis C (HCV)

infection, which each have their own risks for chronic immune-mediated liver

disease (including hepatitis flare after immune reconstitution) and of

direct cytotoxicity. Finally, other factors may affect liver deterioration,

including alcohol-related liver disease, nonalcoholic steatohepatitis

associated with metabolic syndromes (e.g., hyperlipidemia, diabetes, or

being overweight) that are potentially HAART related, and use of medication

or illicit drugs (e.g., methamphetamine). A better understanding of these

complex interactions, including adjustments of dosages of antiretroviral

drugs, will probably help in the management of HIV-infected patients with

liver enzyme abnormalities.