Liver-related complications in human immunodeficiency virus (HIV)-infected patients are increasingly common clinical occurrences as patients have longer life expectancies in the highly active antiretroviral therapy era. The differential diagnosis of abnormal liver function tests in this population is extensive, with many of the etiologies having a significant impact on short-term and long-term morbidity and mortality. Chronic coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) occurs in approximately 10 and 30, respectively, of all HIV-1-infected patients. Although the impact of these viruses on HIV disease remains debated, HIV infection significantly worsens the course of HBV and HCV infection. In addition, treatment of both HBV and HCV is less effective and more toxic in HIV-infected patients than in patients without HIV infection. The presence of HBV and HCV also complicates antiretroviral therapy by increasing rates of drug toxicity and possibly reducing immune reconstitution. With decreasing rates of death due to opportunistic infections and increasing morbidity and mortality due to liver-related complications, it is essential for clinicians caring for patients with HIV to remain abreast of the latest developments in this area.
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