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Liver fibrosis in HIV: Which role does HIV itself, long-term drug toxicities and metabolic changes play?

机译:HIV中的肝纤维化:HIV本身,长期药物毒性和代谢变化起什么作用?

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PURPOSE OF REVIEW: Liver disease is one of the main causes of non-AIDS death in HIV-infected individuals from Europe and North America and has been attributed mainly to coinfection with hepatotropic viruses. However, HIV-induced inflammation as well as long-term antiretroviral drug toxicity may also contribute to clinical relevant liver disease. Therefore, a better understanding of liver disease beyond viral hepatitis coinfection is urgently needed in HIV-infected individuals. RECENT FINDINGS: Cross-sectional fibroscan studies in HIV-infected patient populations have reported unexpectedly high rates of advance fibrosis in HIV-infected patients even without underlying viral hepatitis or alcohol abuse suggesting that HIV itself may contribute independently to liver disease. Finally, HIV therapy itself either through direct hepatotoxicity or long-term metabolic changes, such as dyslipidemia and/or insulin resistance, may additionally cause liver damage in life long treatment. SUMMARY: Therefore, aging of the liver in HIV may play a much more pivotal role in the future considering age-related effects, coinfection with hepatotropic viruses and the toxicity of long-term antiviral treatment. Thus, adequate monitoring of liver disease and development of management algorithms are clearly needed to optimize outcome and care of the aging liver in an HIV-infected individual.
机译:审查目的:肝病是欧洲和北美的HIV感染者非艾滋病死亡的主要原因之一,主要归因于肝炎病毒的合并感染。但是,HIV引起的炎症以及长期的抗逆转录病毒药物毒性也可能导致临床相关的肝病。因此,在HIV感染者中迫切需要对病毒性肝炎合并感染以外的肝脏疾病有更好的了解。最近的发现:在未感染病毒性肝炎或酗酒的情况下,对感染了HIV的患者人群进行的横断面纤维扫描研究报告了出乎意料的高水平的进展性纤维化,即使没有潜在的病毒性肝炎或酒精滥用也表明,HIV本身可能独立地导致了肝病。最后,HIV治疗本身通过直接的肝毒性或长期的代谢变化(例如血脂异常和/或胰岛素抵抗),可能在终身治疗中另外引起肝脏损害。总结:因此,考虑到与年龄相关的影响,与肝细胞病毒的合并感染以及长期抗病毒治疗的毒性,艾滋病毒中肝脏的衰老可能在未来起着更加关键的作用。因此,显然需要对肝脏疾病进行充分的监测并制定管理算法,以优化HIV感染者的结果和对衰老的肝脏的护理。

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