Hepatobiliary Manifestations of Human Immunodeficiency Virus

The development of chronic liver diseases in human immunodeficiency virus (HIV)-infected patients is a growing concern. Coinfection with chronic hepatitis viruses is more frequent in the HIV population because of shared routes of transmission and a lower likelihood of spontaneous clearance. Liver injury in the setting of coinfection is accelerated and leads to a higher rate of complications, resulting in increased morbidity and mortality in this population. Antiretroviral therapy (ART) has substantially decreased the incidence of opportunistic infections, although in immunosuppressed HIV-infected patients the liver and biliary tract are frequent sites of infection. HIV infection and long-term ART are associated with metabolic complications, lipodystrophy, insulin resistance, steatosis, and steatohepatitis, which contribute to the increasing burden of liver disease in HIV-infected patients. Hepatocellular carcinoma is an increasing complication of chronic liver disease in these patients. Fortunately, liver transplant is a promising treatment option for HIV-infected patients with end-stage liver disease.