Table 1.
Potential causes for liver disease in human immunodeficiency virus infection[43]
| Viral hepatitis | HBV, HCV, (HDV) | Co-infection common (up to 10%) |
| HAV, HEV | Self-limited acute increase in ALT | |
| Drug hepatotoxicity | Alcohol | Limited data in low and middle income countries |
| ART1 | Nevirapine | Hypersensitivity, usually early (< 12 wk) |
| Efavirenz | Direct liver cell stress or hypersensitivity | |
| Abacavir | Hypersensitivity, (predominantly in HLA B57 carriers) | |
| ddI, d4T | Mitochondrial toxicity with long-term use | |
| Ritonavir | Steatosis, metabolic disturbance | |
| Darunavir | Hypersensitivity | |
| Tipranavir | Hepatic failure reported with ritonavir 200 mg | |
| Maraviroc | Hypersensitivity with liver involvement | |
| Anti-TB therapy2 | Rifampicin | Drug interactions with ART and direct hepatotoxicity |
| Isoniazid | Hepatotoxicity may be increased in HIV | |
| Pyrazinamide | Dose-related hepatotoxicity | |
| Hepatotropic infections | Schistosomiasis | Leads to portal hypertension |
| Leishmaniasis | Fever +/- hepatosplenomegaly | |
| Herpes viruses inc EBV CMV HHV6 HSV | Often cause raised transaminases, occasionally symptomatic hepatitis | |
| Liver abscess | Unlikely to cause chronic liver disease | |
| HIV cholangiopathy | Usually when CD4 < 200 cells/μL | |
| NAFLD | ART-related, prevalence unknown |
1
Raltegravir rarely causes hepatitis;
2
Ethambutol rarely associated with hepatitis, and may be due to concurrent therapy. HBV: Hepatitis B virus; HCV: Hepatitis C virus; HDV: Hepatitis D virus; HAV: Hepatitis A virus; HEV: Hepatitis E virus; ART: Anti-retroviral therapy; ddI: Didanosine; d4T: Stavudine; TB: Tuberculosis; NAFLD: Non-alcoholic fatty liver disease; EBV: Epstein barr virus; CMV: Cytomegalovirus; HHV: Human herpesvirus; HSV: Herpes simplex virus; HIV: Human immunodeficiency virus; ALT: Alanine aminotransferase; HLA: Human leukocyte antigen.