Liver Disease In HIV Flashcards

1
Q

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

A

Liver disease

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

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2
Q

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

A
Drug induced liver injury 
  - ARV’s, traditional medicines 
Chronic HCV infection 
Chronic HBV infection 
Opportunistic infections 
  - TB
  - CMV
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3
Q

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

A

Kupffner cells.
Hepatic endothelium .
Hepatocytes.

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4
Q

What is NAFLD

A

Non-alcoholic fatty liver disease (NAFLD)

  • This is fatty liver/ liver steatosis
  • In the absence of excessive alcohol intake or HBV/HCV infection
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5
Q

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

A
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
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6
Q

What are common causes of NAFLD in HIV negative patients?

A

Obesity
Dyslipidaemia
Insulin resistance

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7
Q

What are common causes of NAFLD in HIV positive patients?

A
  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
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8
Q

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

A
  • May lead to hyperlactateamia

- Lactic acidosis

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9
Q

How is NAFLD diagnosed?

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