HIV and Liver Disease
Liver disease has been identified as a leading cause of death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART) in 1996. The HIV treatment community has been caught largely unaware of this emerging dilemma. Ma
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Kenneth E. Sherman Editor
HIV and Liver Disease
Editor Kenneth E. Sherman, MD, PhD Gould Professor Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Cincinnati, OH, USA [email protected]
ISBN 978-1-4419-1711-9 e-ISBN 978-1-4419-1712-6 DOI 10.1007/978-1-4419-1712-6 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011936393 © Springer Science+Business Media, LLC 2012 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
Preface
The 1980s saw the emergence of HIV as a devastating disease whose social, political, and scientific ramifications have globally impacted humankind. During the late 1980s and early 1990s, the role and significance of liver disease in the setting of HIV merited little more than a footnote as huge numbers of people died of AIDS-related complications. My own nascent research in the area of hepatitis virus infections in the liver was discouraged by some senior mentors, who considered research effort to study liver disease in patients who faced certain death from AIDS to be both useless and futile. Despite these admonitions, a small cadre of physician-scientists in the USA and Europe were drawn to the scientific window afforded by this experiment of nature that permitted study of liver disease in the setting of a rapidly declining immunologic milieu. The urgency of our investigations was driven by the tragic plight of the patients afflicted with this terrible disease. During this same time period, the hepatitis C virus was “unlocked” and characterized using newly developed molecular tools, which opened the door to study this virus in the setting of HIV infection. New methods also permitted a fresh look at hepatitis B, which had been described early in the AIDS epidemic as a nonissue. By 1991, the era of treating HCV and HBV with nonspecific antiviral agents such as interferon alfa had begun, and most investigators
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