Author Affiliations: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (Drs Kottilil and Polis) and Critical Care Medicine Department, Warren G. Magnuson Clinical Center (Dr Kovacs), National Institutes of Health, Bethesda, Md.
Grand Rounds Section Editor: David S. Cooper, MD, Contributing Editor, JAMA.
Abnormalities in hepatic function have become one of the most common
complications occurring among human immunodeficiency virus (HIV)–infected
individuals receiving highly active antiretroviral therapy (HAART), and liver
disease has become an increasingly important cause of morbidity and mortality
in HIV-infected patients. We present a case of a patient with HIV infection
and hepatotoxicity that exemplifies the complications currently observed during
the treatment of such patients. Hepatotoxicity can be a result of several
factors, including a direct effect of HAART, substance abuse, and coinfection
with either hepatitis C virus (HCV) or hepatitis B virus. Imaging studies
may be helpful in determining the etiology; however, a liver biopsy is often
necessary to be able to more accurately determine the relative contributions
of different processes. Although coinfection with HCV and HIV has become a
common clinical problem, optimal treatment of such patients remains to be
defined and must be individualized to maximize benefit and tolerance.
Kottilil S, Polis MA, Kovacs JA. HIV Infection, Hepatitis C Infection, and HAARTHard Clinical Choices. JAMA. 2004;292(2):243-250. doi:10.1001/jama.292.2.243