Most people living with HIV now have a normal life expectancy as a consequence of effective antiretroviral treatment, and viral suppression with modern therapies has been shown to have a beneficial effect on liver health.

Liver disease remains a leading cause of serious illness and death in people with HIV. Much of this can be attributed to co-infection with HCV and/or hepatitis B virus (HBV), or problematic alcohol use. It is well known that older, and now little used, antiretrovirals can cause liver toxicities. The drugs especially associated with liver damage include unboosted protease inhibitors and certain nucleoside reverse transcriptase inhibitors (NRTIs), including didanosine, zidovudine and stavudine (d4T).

A history of treatment with some older antiretroviral drugs can have a lasting negative impact on liver health, German researchers report in PLOS One. They found that although co-infection with hepatitis C virus (HCV) was the strongest risk factor for liver damage, treatment with didanosine (ddI) and zidovudine (AZT) was also associated with significant liver fibrosis or cirrhosis. Neither of these drugs is now used in routine HIV care, and the study found strong evidence that viral suppression with antiretroviral therapy halved the risk of liver fibrosis in those previously exposed to the drugs.

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