HIV: hepatic manifestations of HIV and antiretroviral therapy

Hepatic manifestations of HIV infection are common and associated with substantial morbidity and mortality. Infectious etiologies of liver disease (hepatitis A, B, and E infections; hepatic complications of tuberculosis) persist despite the gains made through scaling up antiretroviral therapy. Noncommunicable hepatic complications such as malignancy, steatohepatitis, and drug-related disease are also important considerations. Over one-third of people living with HIV have nonalcoholic fatty liver disease. Antiretroviral therapy may cause severe hepatic complications, including hypersensitivity reactions, direct toxicity, immune reconstitution, and mitochondrial toxicity. Approximately 10% of people living with HIV will have severe hepatotoxicity.