Liver Disease In HIV

Question 1

What is the Most common cause of death in HIV patients after AIDS?

Answer 1

Liver disease

- The lower the CD4+ countbthe hugher the risk of dying due to liver disease

Question 2

Name a few etiological factors that increase the risk of developing liver disease:

Answer 2

Drug induced liver injury 
  - ARV’s, traditional medicines 
Chronic HCV infection 
Chronic HBV infection 
Opportunistic infections 
  - TB
  - CMV

Question 3

Name the cells in the liver that contain CD+ cells:

Answer 3

Kupffner cells.
Hepatic endothelium .
Hepatocytes.

Question 4

What is NAFLD

Answer 4

Non-alcoholic fatty liver disease (NAFLD)

• This is fatty liver/ liver steatosis
• In the absence of excessive alcohol intake or HBV/HCV infection

Question 5

The spectrum of NAFLD is divided into 3 bread categories, what are the?

Answer 5

Fatty liver 
  - Accumulates in the liver 
  - Benign
NASH 
  - Fat plus inflammation and scaring
  - Clinically silent lesions frequent on liver biopsy.
Cirrhosis 
  - Scar tissue replaces liver cells 
  - Severe fibrosis

Question 6

What are common causes of NAFLD in HIV negative patients?

Answer 6

Obesity
Dyslipidaemia
Insulin resistance

Question 7

What are common causes of NAFLD in HIV positive patients?

Answer 7

1. Immune activation caused by HIV
2. ART- induced metabolic alterations especially the older medications
   > Stavudine.
   > Didanosine.
   > Usually joe then 6 months on ART (Antiretroviral therapy).
3. Host factors
   > Weight loss, abdominal adiposity, insulin resistance.
   > Dyslipidaemia, Diabetes
4. Other Co-infections:
   > HBV
   > HCV
   > CMV

Question 8

What is a common result of NAFLD, that is used as a marker for its diagnosis?

Answer 8

• May lead to hyperlactateamia

- Lactic acidosis

Question 9

How is NAFLD diagnosed?

Answer 9

• Increase in serum lactate.
  
  • Liver biopsy
  • Increase in ALT, AST, GGT
  • Ultrasound- hyperechogenic