NASH in HIV
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CO-INFECTIONS AND COMORBIDITY (S NAGGIE, SECTION EDITOR)
NASH in HIV Adriana Cervo 1,2 & Mohamed Shengir 3 & Keyur Patel 4 & Giada Sebastiani 5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. Recent Findings Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Summary Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH. Keywords Nonalcoholic steatohepatitis . Liver fibrosis . Metabolic comorbidities . Antiretroviral therapy . Non-invasive diagnostic tests . Interventions
Introduction HIV continues to be a major global public health issue. In 2018, there were approximately 37.9 million people This article is part of the Topical Collection on Co-infections and Comorbidity * Giada Sebastiani [email protected] 1
Division of Infectious Diseases, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
2
Department of Health Promotion Sciences and Mother and Child Care “Giuseppe D’Alessandro”, University of Palermo, Palermo, Italy
3
Division of Experimental Medicine, McGill University, Montreal, Canada
4
Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, Canada
5
Division of Gastroenterology and Hepatology, Chronic Viral Illness Service Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd. Décarie, Montreal QC H4A 3J1, Canada
with HIV (PWH) worldwide [1]. The advent of combination antiretroviral therapy (ART) has considerably improved the health of PWH: in 2018, 50% of PWH in North America were predicted to be over 50 years old [2]. As a consequence, the focus in the management of PWH is shifting to chronic non-infectious comorbidities as both chronic HIV infection itself and long-term ART may affect the trajectory of aging-related conditions [3–5]. Nowadays, mortality
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