Human immunodeficiency virus infection and the liver

Table 1 Potential causes for liver disease in human immunodeficiency virus infection[43]

Viral hepatitis	HBV, HCV, (HDV)	Co-infection common (up to 10%)
	HAV, HEV	Self-limited acute increase in ALT
Drug hepatotoxicity	Alcohol	Limited data in low and middle income countries
ART1	Nevirapine	Hypersensitivity, usually early (< 12 wk)
	Efavirenz	Direct liver cell stress or hypersensitivity
	Abacavir	Hypersensitivity, (predominantly in HLA B57 carriers)
	ddI, d4T	Mitochondrial toxicity with long-term use
	Ritonavir	Steatosis, metabolic disturbance
	Darunavir	Hypersensitivity
	Tipranavir	Hepatic failure reported with ritonavir 200 mg
	Maraviroc	Hypersensitivity with liver involvement
Anti-TB therapy2	Rifampicin	Drug interactions with ART and direct hepatotoxicity
	Isoniazid	Hepatotoxicity may be increased in HIV
	Pyrazinamide	Dose-related hepatotoxicity
Hepatotropic infections	Schistosomiasis	Leads to portal hypertension
	Leishmaniasis	Fever +/- hepatosplenomegaly
	Herpes viruses inc EBV CMV HHV6 HSV	Often cause raised transaminases, occasionally symptomatic hepatitis
	Liver abscess	Unlikely to cause chronic liver disease
HIV cholangiopathy		Usually when CD4 < 200 cells/μL
NAFLD		ART-related, prevalence unknown

¹Raltegravir rarely causes hepatitis;

²Ethambutol rarely associated with hepatitis, and may be due to concurrent therapy. HBV: Hepatitis B virus; HCV: Hepatitis C virus; HDV: Hepatitis D virus; HAV: Hepatitis A virus; HEV: Hepatitis E virus; ART: Anti-retroviral therapy; ddI: Didanosine; d4T: Stavudine; TB: Tuberculosis; NAFLD: Non-alcoholic fatty liver disease; EBV: Epstein barr virus; CMV: Cytomegalovirus; HHV: Human herpesvirus; HSV: Herpes simplex virus; HIV: Human immunodeficiency virus; ALT: Alanine aminotransferase; HLA: Human leukocyte antigen.