Does Hiv Affect The Liver – Microscopic image of liver tissue affected by non-alcoholic fatty liver disease (NAFLD). Large and small white dots are thick droplets that fill the liver cells (hepatocytes). Dr. David Kleiner, NCI
Researchers at the National Institutes of Health and colleagues at Massachusetts General Hospital (MGH) in Boston have found that the injectable hormone tesamorelin reduces liver fat and prevents liver fibrosis (scarring) in people living with HIV. The study was conducted by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Cancer Institute. The results were declared online today
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Does Hiv Affect The Liver
NIAID Director Anthony S. Fauci, MD, said, “Many people living with HIV have overcome significant obstacles to live long, healthy lives,” said NIAID Director Anthony S. Fauci. HIV may be effective in treating nonalcoholic fatty liver disease.
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Nonalcoholic fatty liver disease, or NAFLD, is common with HIV, affecting up to 25% of people living with HIV in the developed world. However, there is currently no effective treatment for this disease, which is a risk factor for progressive liver disease and liver cancer. Colleen M., senior physician scientist at the NIAID Immunoregulation Laboratory. The researchers, who led the letter and head of the Department of Metabolism at MGH, Stephen K. Grinspoon tested whether tesamorelin could reduce liver fat in men and women. – Both HIV. and NAFLD. Among the enrolled participants, 43% had mild fibrosis, and 33% met diagnostic criteria for a more severe subtype of NAFLD called nonalcoholic steatohepatitis (NASH). Thirty-one participants were randomized to receive a 2-mg daily injection of tesamorelin, and 30 were randomized to receive a placebo-like injection. The researchers provided all participants with nutritional advice and also taught them how to self-administer their daily injections. The researchers then compared measures of liver health in both groups at baseline and 12 months.
After one year, participants who received tesamorelin had better liver health than those who received a placebo, as measured by a reduction in the fatty fraction (HFF)—a measure of fat in other liver tissues. HFF health range is less than 5%. Thirty-five percent of study participants who received tesamorelin achieved normal HFF, while only 4% of those who received placebo achieved this range with dietary counseling. In general, tesamorelin reduced the HFF participants with a good way and an absolute difference of 4.1% (relative to a reduction of 37% from the beginning of the study). Nine participants in the placebo group experienced an increase in placebo or fibrosis, while only two participants in the tesamorelin group experienced the same event. In addition, levels of several blood markers related to inflammation and liver damage, including the enzyme alanine aminotransferase (ALT), were reduced among those who received tesamorelin compared to those who received placebo, particularly among those whose levels were elevated at the start of the study.
Given these positive results, the researchers recommend expanding the indication of tesamorelin to include people living with HIV diagnosed with NAFLD. They also recommend that further studies be conducted to determine whether tesamorelin can contribute to long-term protection against severe liver disease in people without HIV infection.
“Our hope is that this intervention can help people living with HIV, as well as HIV-negative people with liver abnormalities,” Dr. Hadigan said. “Further studies will tell us about the long-term benefits of this approach and may lead to the development of drugs that can help everyone with liver disease, regardless of HIV status.”
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Egrifta (tesamorelin) was approved by the US in 2010. Food and Drug Administration to reduce excess abdominal fat in patients with HIV infection with lipodystrophy – a disease characterized by abnormal distribution of body fat, initially associated with older classes of HIV infection. Common adverse reactions testing Egrifta in previous clinical trials included joint pain (arthralgia), skin redness and rash at the injection site (erythema and itching), abdominal pain, swelling, and muscle pain (myalgia). Worsening of diabetes control was greater in participants treated with Egrifta than placebo.
“Because tesamorelin has been shown to be effective in treating abnormal obesity in people with HIV and using related drugs, we hypothesized that the drug would reduce fat accumulation in the liver and cause damage in the same people,” said Dr. Grinspoon.
Although liver disease is often associated with heavy alcohol consumption, NAFLD occurs in excess fatty liver without alcohol consumption. This condition can progress to liver damage, cirrhosis, or cancer, which can be life-threatening and require a liver transplant.
Previous studies have found that vitamin E supplements, weight loss, and other lifestyle changes may improve outcomes in HIV-negative people with NASH. However, treatment options for NASH and NAFLD remain untested in HIV-infected individuals and none exist in this group. Obesity and type 2 diabetes increase the risk of NAFLD regardless of HIV status, and people with HIV are at greater risk for NAFLD because some HIV medications and HIV itself are associated with and contribute to abdominal fat accumulation.
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This research was supported by NIAID grant U01 AI115711. For more information about this trial, visit ClinicalTrials.gov under study ID NCT02196831.
NIAID conducts and supports research in the United States and around the world to investigate the causes of infectious and immune diseases and to develop better ways to prevent, diagnose, and treat these diseases. News, fact sheets, and other materials related to NIAID are available on the NIAID website.
About the National Institutes of Health (NIH): The National Agency for Medical Research, includes 27 centers and centers and is part of the US Department of Health and Human Services. is the primary federal agency that conducts and supports basic, clinical, and translational medical research that investigates the causes, treatments, and cures of common and rare diseases. For more information on its procedures, please visit .Objective To describe the various mechanisms of liver disease in HIV-infected patients and to relate these mechanisms to applicable disease conditions.
Non-AIDS causes of morbidity and mortality are more common among patients living with background HIV. In particular, liver-related diseases have become one of the leading causes of AIDS-related deaths. A thorough understanding of the mechanisms that drive the development of liver disease in these patients is important in the evaluation and care of these patients.
Pdf) Seroprevalence Of Hepatitis C Virus In Hiv/aids Patients In Jos, Nigeria
Methods The literature on the mechanisms of liver diseases was reviewed and compiled.
Results revealed a number of distinct mechanisms of injury, including: oxidative stress, mitochondrial injury, lipotoxicity, immune-mediated injury, cytotoxicity, accumulation of toxic metabolites, intestinal microbial translocation, and systemic inflammation. , aging and nodular regenerative hyperplasia. Diseased states can use any number of these mechanisms to exert their effects on the liver.
Conclusions There are multiple mechanisms of liver injury in HIV-infected patients. Many diseases use multiple mechanisms to cause liver damage and fibrosis.
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Since the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, HIV has become a manageable (though not curable) disease. Mortality in people living with HIV infection.1 In particular, liver-related diseases are significantly increasing among people living with HIV infection. For example, 5%–25% of patients with hepatitis B virus (BVV), 2 30% with hepatitis C virus (HCV) 3 , and 30%–40% of patients may show symptoms of liver disease. fatty acids. (NAFLD).4 Liver-related diseases account for 13%-18% of all causes of death in HIV-infected patients and are one of the leading causes of non-AIDS-related death.5-7 Therefore, early recognition and diagnosis of liver disease in its early stages is key. is an important part of ensuring that morbidity and mortality in the population continue to improve.
Liver disease in people living with HIV depends on immune function. Data from the Centers for AIDS Research (CFAR) Integrated Clinical Systems Research Group have shown that poor control of HIV monoinfection is an independent risk factor for liver fibrosis.8 The development of cirrhosis is the most clinically relevant form of liver damage. A detailed description of the mechanisms of liver fibrogenesis is beyond the scope of this review. However, there are few publications that provide detailed information on the latter approach.9 Patients with HIV infection (HIV RNA suppressed and CD4 count restored) develop liver disease for simple reasons.
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