Elevated Liver Enzymes in HIV Monoinfected Patients on HIV Therapy: What Are the Implications?(Leading Article) (Human Immunodeficiency Virus) (Report‪)‬

Liver enzyme elevations (LEE) in patients infected with the human immunodeficiency virus (HIV) are common [1]. In some cases they are transient and of minor clinical interest, in other cases they are caused by alcohol consumption or by co-infection with other viral diseases, such as hepatitis B virus (HBV) infection or hepatitis C virus (HCV) infection. However, in an important number of patients the origin of liver enzyme elevation is not explained by an underlying liver disease or toxin and may occur either due to antiretroviral drug toxicity or the HIV infection itself. As HIV patients benefit from their antiretroviral treatment (ART) and consequent immunological stabilisation [2,3], continuous long-term treatment is inevitable. Although ART clearly has prolonged survival benefit for patients, it has led to a number of unexpected drug-induced toxicities: lipodystrophy, insulin resistance, dyslipidaemia and direct hepatotoxic injury [4]. Transaminase elevations have been described during antiretroviral treatment by various mechanisms, leading to morbidity, mortality and drug discontinuation [5]. Consequently, prevention and management of antiretroviral drug-related liver injury have emerged as major issues among HIV-infected patients in the era of combination ART [6].