Published online Jan 28, 2019. doi: 10.3748/wjg.v25.i4.398
Peer-review started: November 30, 2018
First decision: January 11, 2019
Revised: January 15, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: January 28, 2019
Hepatotropic viruses induced hepatitis progresses much faster and causes more liver- related health problems in people co-infected with human immunodeficiency virus (HIV). Although treatment with antiretroviral therapy has extended the life expectancy of people with HIV, liver disease induced by hepatitis B virus (HBV) and hepatitis C virus (HCV) causes significant numbers of non-acquired immune deficiency syndrome (AIDS)-related deaths in co-infected patients. In recent years, new insights into the mechanisms of accelerated fibrosis and liver disease progression in HIV/HCV and HIV/HBV co-infections have been reported. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease in HIV-HCV/HBV co-infection in the era of direct acting antivirals (DAA) and antiretroviral therapy (ART). We also review the novel therapeutics for management of HIV/HCV and HIV/HBV co-infected individuals.
Core tip: In this review, we summarized the literature and our recent findings on liver damage associated with co-infection with human immunodeficiency virus (HIV) and hepatotropic viruses [hepatitis C virus (HCV), hepatitis B virus (HBV)]. The combination of HIV with HCV or HBV causes progressive liver injury and chronic liver inflammation ultimately leading to end-stage liver disease, such as cirrhosis and hepatocellular carcinoma. These outcomes are related to many events including apoptosis-mediated cross-talk between liver parenchymal and non-parenchymal cells, accumulation of inflammatory cells in the liver, microbial translocation and impaired immune responses. The treatment of these co-infections requires the combination of direct acting antiviral (DAA) and antiretroviral therapy (ART) for HCV + HIV and comparatively high doses of DAA for HBV, which should be controlled for drug-drug interactions to avoid hepatotoxicity.