Anti-HIV Therapy and the Development of Chronic Liver Diseases

Dear Colleagues, 

Since the introduction of combined antiretroviral therapy (cART) in the mid-1990s, HIV infection has become a manageable chronic disease. As HIV-infected patients now live significantly longer, non-AIDS illnesses have become a major cause of morbidity and mortality in this population. In particular, liver-related diseases which are becoming increasingly prominent in HIV-infected individuals are considered one of the leading causes of non-AIDS-related death accounting for 13–18% of all-cause mortality in these patients. 

Patients with controlled HIV infection (suppressed HIV RNA and restored CD4 counts) under long-term treatment develop liver diseases from a variety of causes, including alcohol consumption, NAFLD, and viral hepatitis, in addition to more HIV-specific processes such as cART-related toxicity and direct injury to the liver caused by the HIV virus itself. Intense research over the recent years has shown that the pathogenesis of these conditions involves increased levels of local and systemic inflammation, hepatic fibrogenesis that results in various degrees of liver fibrosis, and altered immunity. The mechanisms that have been described to underlie these processes involve but are not limited to oxidative stress, mitochondrial dysfunction, lipotoxicity, immune-mediated injury, direct cytotoxicity and toxic metabolite accumulation, gut microbial translocation, and senescence. Nevertheless, how these processes are interconnected and what their exact pathophysiological contribution is are still not clear. Moreover, the specificity of the therapeutic and prophylactic approaches for liver diseases in the context of HIV infection needs to be studied in greater detail. With this in mind, a broad understanding of the pathogenesis of liver injury, and in particular linking of these mechanisms to the different forms and outcomes of liver pathologies in HIV patients, would be of great utility to clinicians caring for HIV-infected patients. 

The aim of this Special Issue is to assemble cutting-edge basic and clinical research which elucidates the processes involved in the development/progression of chronic liver diseases in HIV-infected patients under treatment. The suggested topics of interest may include:

• Pathophysiological changes in the liver of HIV patients;
• Intercellular communication in the liver;
• Gut–liver axis;
• Liver-derived extracellular vesicles;
• Antiretroviral drug-specific specific liver toxicity;
• Altered liver metabolism in HIV patients;
• Altered immunity and development of chronic liver disease.

Prof. Nadezda Apostolova
Guest Editor

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• HIV
• Antiretroviral drugs
• Liver
• Toxicity
• Chronic hepatic disease