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World J Hepatol. Mar 27, 2012; 4(3): 91-98
Published online Mar 27, 2012. doi: 10.4254/wjh.v4.i3.91
Human immunodeficiency virus infection and the liver
Megan Crane, David Iser, Sharon R Lewin
Megan Crane, Sharon R Lewin, Department of Medicine, Monash University, Melbourne 3004, Australia
Megan Crane, Sharon R Lewin, Centre for Virology, Burnet Institute, Melbourne 3004, Australia
David Iser, Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3004, Australia
David Iser, Sharon R Lewin, Infectious Disease Unit, The Alfred, Melbourne 3004, Australia
Author contributions: Crane M, Iser D and Lewin SR all contributed equally to writing this manuscript.
Supported by An NHMRC Practitioner Fellowship to Lewin SR; an amFAR Mathilde Krim Fellowship in Basic Biomedical Science to Crane M; and an NHMRC postgraduate scholarship to Iser D
Correspondence to: Sharon R Lewin, Professor, Director, Infectious Diseases Unit, The Alfred, Level 2, Burnet Building, 85 Commercial Rd, Melbourne 3004, Australia.
Telephone: +61-3-90768491 Fax: +61-3-90762431
Received: February 28, 2011
Revised: November 4, 2011
Accepted: March 17, 2012
Published online: March 27, 2012

Liver disease in human immunodeficiency virus (HIV)-infected individuals encompasses the spectrum from abnormal liver function tests, liver decompensation, with and without evidence of cirrhosis on biopsy, to non-alcoholic liver disease and its more severe form, non-alcoholic steatohepatitis and hepatocellular cancer. HIV can infect multiple cells in the liver, leading to enhanced intrahepatic apoptosis, activation and fibrosis. HIV can also alter gastro-intestinal tract permeability, leading to increased levels of circulating lipopolysaccharide that may have an impact on liver function. This review focuses on recent changes in the epidemiology, pathogenesis and clinical presentation of liver disease in HIV-infected patients, in the absence of co-infection with hepatitis B virus or hepatitis C virus, with a specific focus on issues relevant to low and middle income countries.

Keywords: Human immunodeficiency virus, Liver disease, Low-middle income settings