Aging of the Liver: What This Means for Patients with HIV

Chan, Austin; Patel, Yuval A.

doi:10.1007/s11904-016-0332-x

Cited by 11 publications

(16 citation statements)

References 108 publications

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“…Age is a well-known risk factor for LF in non-alcoholic fatty liver disease (NAFLD) and HCV-infected patients (Chan, Patel & Choi, 2016). However, data about age-related fibrosis in the HIV mono-infected population are scarce (Rockstroh et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism, however, remains unknown. The decreased regenerative capacity, microbial translocation and HIV-induced immunologic dysfunction as well as chronic inflammation may play non-mutually exclusive roles (Chan, Patel & Choi, 2016). This result was also in line with our other finding, the identified remarkable negative association between LS and CD4/8 ratio.…”

Section: Discussionmentioning

confidence: 99%

“…Data suggesting HIV-induced effects on the pathogenesis of fibrosis generation has been described mainly in patients with HIV/HCV co-infection (Rockstroh et al, 2014) but the mechanism has still not been exactly determined. In context of the ageing HIV population, a better understanding of how ageing interacts with HIV-induced immunologic and metabolic changes will have paramount importance in reducing the burden of liver diseases (Chan, Patel & Choi, 2016). …”

Section: Discussionmentioning

confidence: 99%

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Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Sulyok

Ferenci

Makara

et al. 2017

PeerJ

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BackgroundLiver disease has become an important cause of morbidity and mortality even in those HIV-infected individuals who are devoid of hepatitis virus co-infection. The aim of this study was to evaluate the degree of hepatic fibrosis and the role of associated factors using liver stiffness measurement in HIV mono-infected patients without significant alcohol intake.MethodsWe performed a cross-sectional study of 101 HIV mono-infected patients recruited prospectively from March 1, 2014 to October 30, 2014 at the Center for HIV, St István and St László Hospital, Budapest, Hungary. To determine hepatic fibrosis, liver stiffness was measured with transient elastography. Demographic, immunologic and other clinical parameters were collected to establish a multivariate model. Bayesian Model Averaging (BMA) was performed to identify predictors of liver stiffness.ResultsLiver stiffness ranged from 3.0–34.3 kPa, with a median value of 5.1 kPa (IQR 1.7). BMA provided a very high support for age (Posterior Effect Probability-PEP: 84.5%), moderate for BMI (PEP: 49.3%), CD4/8 ratio (PEP: 44.2%) and lipodystrophy (PEP: 44.0%). For all remaining variables, the model rather provides evidence against their effect. These results overall suggest that age and BMI have a positive association with LS, while CD4/8 ratio and lipodystrophy are negatively associated.DiscussionOur findings shed light on the possible importance of ageing, overweight and HIV-induced immune dysregulation in the development of liver fibrosis in the HIV-infected population. Nonetheless, further controlled studies are warranted to clarify causal relations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Sulyok

Ferenci

Makara

et al. 2017

PeerJ

View full text Add to dashboard Cite

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“…Manuscript to be reviewed BMA revealed age as the most important predictor of LS. Age is a well-known risk factor for LF in non-alcoholic fatty liver disease (NAFLD) and HCV-infected patients (Chan et al 2016). However, data about age-related fibrosis in the HIV mono-infected population are scarce (Rockstroh et al 2014).…”

Section: Discussionmentioning

confidence: 99%

Peer Review #1 of "Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals (v0.1)"

Monde¹

2017

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Background. Liver disease has become an important cause of morbidity and mortality even in those HIV-infected individuals who are devoid of hepatitis virus co-infection. The aim of this study was to evaluate the degree of hepatic fibrosis and the role of associated factors using liver stiffness measurement in HIV mono-infected patients without significant alcohol intake. Methods. We performed a cross-sectional study of 101 HIV mono-infected

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“…31 Furthermore, HIV and HCV coinfection leads to faster progression to fibrosis and cirrhosis in addition to an increased risk of hepatocellular carcinoma compared with HCV monoinfection. 32 However, a recent meta-analysis concluded that effective antiretroviral therapy may reduce liverrelated mortality among patients with dual infection. 33 Most cases of HIV-HCV coinfection occur in patients who use illicit intravenous drugs.…”

Section: Liver Diseasementioning

confidence: 99%

Managing HIV infection in patients older than 50 years

McMillan

Krentz

Gill

et al. 2018

CMAJ

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A ntiretroviral therapy has extended the life expectancy of people living with HIV, 1-4 although disparities remain. Patients who are not white, who begin antiretroviral therapy with CD4 cell counts below 350 cells/µL or who use illicit intravenous drugs do not live as long; 5 however, the Centers for Disease Control and Prevention (CDC) estimated that, by 2020, more than half of all people living with HIV in the United States will be older than 50 years of age. 6 The age threshold used to define older people living with HIV is 50 years. Numbers of older people living with HIV have also increased in Canada. In 1997, 10% of patients receiving HIV care at the Southern Alberta Clinic in Calgary were older than 50 years of age; in 2017, such patients accounted for 48% of care recipients. The primary reason for this change is the aging of people who acquired infection earlier in life. However, adults older than 50 years of age now account for almost one in six new HIV infections in Canada and the US. 5-7 There are distinct differences between people who are aging with HIV and patients who seroconvert in older age. 8 People who have aged with HIV infection have high rates of comorbid illness at younger ages than people without HIV infection, which leads to increased complexity in the provision of clinical care. Here, we focus on aging with HIV, exploring the effects of many years of infection and treatment on the development and progression of comorbidities. We provide guidance for nonspecialist physicians who are increasingly likely to be involved in the prevention and management of non-HIV related comorbidities in patients older than 50 years. We particularly draw on recent evidence from randomized controlled trials and large cohort and case-control studies (Box 1). What contributes to the burden of comorbidity in older patients with HIV and AIDS? Older people living with HIV are more likely to have complicating comorbidities and polypharmacy, leading to possible drug-disease and drug-drug interactions that can be complicated by age-related pharmacokinetic and pharmacodynamic changes. The risk of resistance to antiretroviral therapy and toxicity is increased because of the long duration of infection. 7 Observational studies have estimated that the prevalence of select age-related comorbidities among these patients approaches that seen among people without HIV infection who are 5 years older, 9 and the risk of multimorbidity for these patients is similar to that of people without HIV infection who are 10-15 years older. 10 One study found that patients older than 45 years of age living with HIV had higher multimorbidity than was seen in those with a new infection who were of a similar age. 11 However, it is not clear whether the relatively earlier occurrence of comorbidities among people living with HIV is the result of accelerated or accentuated aging. 12 In the former, the aging process itself

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Aging of the Liver: What This Means for Patients with HIV

Cited by 11 publications

References 108 publications

Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Peer Review #1 of "Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals (v0.1)"

Managing HIV infection in patients older than 50 years

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