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JAC Advance Access published online on July 19, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl280
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

HAART attenuates liver fibrosis in patients with HIV/HCV co-infection: fact or fiction?

Sumita Verma 1 *

1 Division of Gastroenterology and Hepatology, Johns Hopkins University Hospital, 1830 East Monument Street, Suite 424, Baltimore, MD 21205, USA

* To whom correspondence should be addressed.
Sumita Verma, E-mail: sverma5{at}jhmi.edu


  Abstract

Since highly active antiretroviral therapy (HAART) has significantly improved survival in patients with HIV, liver disease from hepatitis C virus (HCV) infection is now an important cause of morbidity and mortality in such a cohort. Studies assessing liver fibrosis in an HIV/HCV cohort are beset with methodological flaws and heterogeneity of the study population, precluding definite conclusions. Nonetheless, recent data (albeit from retrospective studies) do suggest that HAART can attenuate liver fibrosis in the co-infected cohort with fibrosis progression rates comparable to the mono-infected patients. This is especially true for those patients whose HIV was diagnosed after 1996 and for whom HAART is associated with successful viral suppression. The mechanism/s underlying this favourable course of events however remain speculative but could be related to immune restoration-induced changes in inflammatory and fibrogenic cytokines or to a direct effect of HAART on hepatic fibrosis. Therefore with the current available evidence it seems unjustifiable to defer HAART in those that need it because of concerns regarding potential hepatotoxicity as the benefits (both from the HIV and HCV viewpoint) probably outweigh any potential risks. Nonetheless, this issue can only be unequivocally resolved by better designed prospective studies.

Keywords: HAART hepatotoxicity; hepatic necroinflammation; hepatic fibrosis; CD4 count; HIV VL.
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