Liver Disease In HIV Flashcards
What is the Most common cause of death in HIV patients after AIDS?
Liver disease
- The lower the CD4+ countbthe hugher the risk of dying due to liver disease
Name a few etiological factors that increase the risk of developing liver disease:
Drug induced liver injury - ARV’s, traditional medicines Chronic HCV infection Chronic HBV infection Opportunistic infections - TB - CMV
Name the cells in the liver that contain CD+ cells:
Kupffner cells.
Hepatic endothelium .
Hepatocytes.
What is NAFLD
Non-alcoholic fatty liver disease (NAFLD)
- This is fatty liver/ liver steatosis
- In the absence of excessive alcohol intake or HBV/HCV infection
The spectrum of NAFLD is divided into 3 bread categories, what are the?
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
What are common causes of NAFLD in HIV negative patients?
Obesity
Dyslipidaemia
Insulin resistance
What are common causes of NAFLD in HIV positive patients?
- Immune activation caused by HIV
- ART- induced metabolic alterations especially the older medications
> Stavudine.
> Didanosine.
> Usually joe then 6 months on ART (Antiretroviral therapy). - Host factors
> Weight loss, abdominal adiposity, insulin resistance.
> Dyslipidaemia, Diabetes - Other Co-infections:
> HBV
> HCV
> CMV
What is a common result of NAFLD, that is used as a marker for its diagnosis?
- May lead to hyperlactateamia
- Lactic acidosis
How is NAFLD diagnosed?
- Increase in serum lactate.
- Liver biopsy
- Increase in ALT, AST, GGT
- Ultrasound- hyperechogenic