TY - JOUR
T1 - A Review of Non-Alcoholic Fatty Liver Disease in HIV-Infected Patients
T2 - The Next Big Thing?
AU - van Welzen, Berend J
AU - Mudrikova, Tania
AU - El Idrissi, Ayman
AU - Hoepelman, Andy I M
AU - Arends, Joop E
N1 - Funding Information:
Disclosures. Berend J. van Welzen, Ayman El Idrissi and Tania Mudrikova have nothing to disclose. Andy I.M. Hoepelman: Advisory boards fees from Abbvie, BMS, Gilead, Janssen, MSD. Consultancy: AbbVie. Joop E. Arends: Advisory board fees from Gilead, MSD, Janssen, ViiV, Abbvie and BMS. (Research) grants from MSD, Abbvie, ViiV and BMS (money is paid to the institution).
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/3
Y1 - 2019/3
N2 - The burden of liver-related morbidity remains high among HIV-infected patients, despite advances in the treatment of HIV and viral hepatitis. Especially, the impact of non-alcoholic fatty liver disease (NAFLD) is significant with a prevalence of up to 50%. The pathogenesis of NAFLD and the reasons for progression to non-alcoholic steatohepatitis (NASH) are still not fully elucidated, but insulin resistance, mitochondrial dysfunction and dyslipidemia seem to be the main drivers. Both HIV-infection itself and combination antiretroviral therapy (cART) can contribute to the development of NAFLD/NASH in various ways. As ongoing HIV-related immune activation is associated with insulin resistance, early initiation of cART is needed to limit its duration. In addition, the use of early-generation nucleoside reverse transcriptase inhibitors and protease inhibitors is also associated with the development of NAFLD/NASH. Patients at risk should therefore receive antiretroviral drugs with a more favorable metabolic profile. Only weight reduction is considered to be an effective therapy for all patients with NAFLD/NASH, although certain drugs are available for specific subgroups. Since patients with NASH are at risk of developing liver cirrhosis and hepatocellular carcinoma, several non-antifibrotic and antifibrotic drugs are under investigation in clinical trials to broaden the therapeutic options. The epidemiology and etiology of NAFLD/NASH in HIV-positive patients is likely to change in the near future. Current guidelines recommend early initiation of cART that is less likely to induce insulin resistance, mitochondrial dysfunction and dyslipidemia. In contrast, as a result of increasing life expectancy in good health, this population will adopt the more traditional risk factors for NAFLD/NASH. HIV-treating physicians should be aware of the etiology, pathogenesis and treatment of NAFLD/NASH in order to identify and treat the patients at risk.
AB - The burden of liver-related morbidity remains high among HIV-infected patients, despite advances in the treatment of HIV and viral hepatitis. Especially, the impact of non-alcoholic fatty liver disease (NAFLD) is significant with a prevalence of up to 50%. The pathogenesis of NAFLD and the reasons for progression to non-alcoholic steatohepatitis (NASH) are still not fully elucidated, but insulin resistance, mitochondrial dysfunction and dyslipidemia seem to be the main drivers. Both HIV-infection itself and combination antiretroviral therapy (cART) can contribute to the development of NAFLD/NASH in various ways. As ongoing HIV-related immune activation is associated with insulin resistance, early initiation of cART is needed to limit its duration. In addition, the use of early-generation nucleoside reverse transcriptase inhibitors and protease inhibitors is also associated with the development of NAFLD/NASH. Patients at risk should therefore receive antiretroviral drugs with a more favorable metabolic profile. Only weight reduction is considered to be an effective therapy for all patients with NAFLD/NASH, although certain drugs are available for specific subgroups. Since patients with NASH are at risk of developing liver cirrhosis and hepatocellular carcinoma, several non-antifibrotic and antifibrotic drugs are under investigation in clinical trials to broaden the therapeutic options. The epidemiology and etiology of NAFLD/NASH in HIV-positive patients is likely to change in the near future. Current guidelines recommend early initiation of cART that is less likely to induce insulin resistance, mitochondrial dysfunction and dyslipidemia. In contrast, as a result of increasing life expectancy in good health, this population will adopt the more traditional risk factors for NAFLD/NASH. HIV-treating physicians should be aware of the etiology, pathogenesis and treatment of NAFLD/NASH in order to identify and treat the patients at risk.
KW - Antiretroviral therapy
KW - Fibrosis
KW - HIV
KW - NASH
KW - Non-alcohol fatty liver disease
UR - http://www.scopus.com/inward/record.url?scp=85061501148&partnerID=8YFLogxK
U2 - 10.1007/s40121-018-0229-7
DO - 10.1007/s40121-018-0229-7
M3 - Review article
C2 - 30607807
SN - 2193-8229
VL - 8
SP - 33
EP - 50
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
IS - 1
ER -