HIV- Related Liver Disease- Symptoms, Diagnosis, and Treatment

Introduction:

HIV (human immunodeficiency virus) is a virus that can attack the immune system of a healthy human body and lead to AIDS (acquired immunodeficiency syndrome). This virus can be transmitted by contacting infected blood, semen, or vaginal fluids. In the initial stages, the disease is asymptomatic, but as the disease progresses to AIDS, many serious diseases and infections result in the body. There is no cure for AIDS, but strict adherence to antiretroviral regimens (ARVs) can slow its infections and complications.

The liver is the largest vital organ of the human body, and it is very important that the liver functions properly and efficiently for a healthy life in the individual body. Especially in people with HIV, it plays a lead role in metabolizing HIV drugs. HIV always causes an issue that affects the liver and infects liver cells. Inflammation of the liver is unavoidable in the case of HIV. Also, HIV medication is responsible for liver damage.

What Is HIV- Related Liver Disease?

HIV (human immunodeficiency virus) attacks the immune system and can lead to various conditions and infections of the liver. Diseased conditions like hepatitis A, B, and C, liver fibrosis, cirrhosis, fatty liver, NASH (non-alcoholic steatohepatitis), hepatotoxicity, and hepatocellular carcinoma can occur. In detail, the associated diseases are:

• Hepatitis A spreads through contaminated food and water or unsafe sex. It can cause short-term, acute, or chronic illness. Most of the time, hepatitis A recovers without treatment, and it does not lead to rare complications. The vaccine is present, which can minimize complications. People with HIV, along with hepatitis A have inflamed livers and may not be able to process anti-HIV drugs and other medicines, which can lead to worse side effects.

• Hepatitis B usually passes from mother to child during pregnancy, coming in contact with infected blood or through unprotected sex. HIV-infected people can also complicate the process of hepatitis B drugs and lead to serious liver function. The vaccine is present, which can prevent the condition.

• Hepatitis C is a blood-borne virus that spreads through contaminated blood products, mother-to-child, sharing needles, injecting drugs, and unprotected sex. No vaccine is present for this.

• Alcohol consumption, along with this condition, can be even worse. The condition can cause serious infections like liver cirrhosis and can be life-threatening.

• HIV-associated Malignancies: Kaposi sarcoma (KS) and lymphoma (Hodgkins and non-Hodgkin's lymphoma) are present, and liver involvement in AIDS malignancy lymphoma can often be present first in the liver.

• Hepatocellular carcinoma (HIV increases the risk and prevalence of hepatocellular carcinoma).

• Fatty liver (HIV increases the risk of the fatty liver), most commonly known as NAFLD (non-alcoholic fatty liver disease).

• NASH (non-alcoholic steatohepatitis): Increased liver fibrosis due to chronic HIV infection.

• Hepatotoxicity: Antiretroviral drugs used to treat HIV can lead to liver hepatotoxicity. The liver is the main organ involved in processing drugs, so this toxicity leads to severe damage to the liver.

Untreated HIV can increase the risk of liver problems. Some anti-HIV drugs, like Nevirapine (Viramune) and other prescription medications, can cause immense damage to the liver to become inflamed. Severe damage can increase the risk of liver cancer which can be fatal.

What Is the Cause Of HIV-Related Liver Disorder?

The causes of HIV-related disorders are:

• Coming in contact with infected blood, semen, or vaginal fluids.

• Coming in contact with infected syringes.

• Unprotected sex.

• Contaminated water and food.

• Excessive alcohol consumption.

• Traveling to countries more prone to hepatitis A and B virus.

What Are the Signs and Symptoms of HIV-Related Liver Disorder?

The most common signs and symptoms that the patients present are:

• Scleral Icterus: The liver is involved in bilirubin processing. Thus, in infected liver conditions, there is a rise in bilirubin in the blood, leading to jaundice. The sclera's yellowish pigmentation is sclera icterus due to bilirubin's high pigmentation.

• Hepatomegaly: It is the enlargement of the liver found in patients with liver disease and can reflect liver involvement in HIV-associated malignancies.

• Fatigue.

• Loss of appetite.

• Fever.

• Ascites.

• Yellowish discoloration of the skin.

• Skin-leukonychia (white fingernails), finger clubbing, jaundice, spider nevi.

How Is the Diagnosis Made For HIV-Related Liver Disorder?

Diagnosis of this condition is based on various laboratory tests, imaging tests, and viral tests:

Laboratory Tests:

• Test for Liver Enzymes- Aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT).

• Bilirubin Test- A test that measures the level of bilirubin in the blood.

• Alkaline Phosphatase- This group of enzymes is normally found in the liver. When the liver ducts are blocked, or it does not function properly, AP (alkaline phosphatase) is not released into the bloodstream.

• International Normalized Ratio (INR) - It is a test to check blood clotting and monitor Warfarin therapy. INR is a reliable test for synthetic liver function in liver disease.

• Albumin- Albumin is a protein made by the liver; its level decreases in chronic liver diseases like cirrhosis.

Viral Hepatitis Testing:

a) Hepatitis A: Detection of anti-HAV IgM antibodies.

b) Hepatitis B: In chronic HBV infection, the presence of HBS-Ag is seen. In acute HBV infection, HBc-IgM antibodies are detected.

c) Hepatitis C: In the case of HCV-positive HCV-RN antibodies, detection is done.

d) Hepatitis D Test: Test to detect hepatitis D antibodies in the blood.

e) Hepatitis E Test: Test to detect anti-HEV immunoglobulin antibodies in the blood.

f) Alpha-fetoprotein (AFP): It is a protein normally made by immature liver cells in fetuses; infants have a high level of AFP, but the normal level in adults is below ten ng/ml. An increase in levels of AFP indicates liver cancer; elevation of AFP levels can be 60 percent in liver cancer patients.

Imaging Test:

• Ultrasound of the abdomen.
• CT (computed tomography) scan.
• MRI (magnetic resonance imaging).
• Fibroscan.
• Upper GI endoscopy.

Biopsy: A biopsy of the liver is done to know the severity of the disease. A biopsy can help differentiate between a flare of underlying chronic liver hepatitis or the drug's toxicity.

What Is the Treatment For HIV-Related Liver Disorder?

Treatment is mainly based on treating the cause,

• Strict follow-up in the HIV medication regime and controlled HIV can help control this complication.

• Hepatitis A is usually manageable by drinking plenty of water, resting, and avoiding alcohol. Vaccination can prevent this condition to a greater extent.

• Hepatitis B is treated the same as drugs used in HIV; this is also manageable by following hygiene protocols.

Treatment protocols for treating hepatitis C:

1. Maintaining overall liver health.

2. HIV patients are always advised to take vaccinations for Hepatitis A and B.

3. Avoid unprotected sex.

4. Avoid consuming excessive alcohol.

5. Avoid poor sanitization and maintain hygiene.

6. Use sterile injections.

7. Avoid recreational drugs.

Conclusion:

Untreated HIV can increase the risk of liver disease. In the early stage, this condition might not show any kind of signs or symptoms. Once HIV is detected, its medication and regular medical check-up of individuals should be followed. A check on liver function should be monitored as a part of an HIV routine check-up so that early detection of the condition can be done. Most liver complications are associated with HIV, so early detection and treatment are necessary to control the condition before it becomes fatal.