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International Journal of Hepatology
Volume 2012 (2012), Article ID 760706, 23 pages
Review Article

HIV-Antiretroviral Therapy Induced Liver, Gastrointestinal, and Pancreatic Injury

1Departments of Clinical Pharmacology and Toxicology, and Global Health, University of Toronto, ON, Canada M5G 1X8
2In Vitro Drug Safety and Biotechnology, University of Toronto, MaRS Discovery District, 101 College Street, Suite 300, Lab 351, Toronto, ON, Canada M5G 1L7
3Alcohol & Drug Abuse Research Unit, Medical Research Council, Tygerberg (Cape Town), South Africa
4Department of Psychiatry, Stellenbosch University, Tygerberg (Cape Town), South Africa

Received 26 November 2011; Revised 30 December 2011; Accepted 1 January 2012

Academic Editor: Lawrence Cohen

Copyright © 2012 Manuela G. Neuman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The present paper describes possible connections between antiretroviral therapies (ARTs) used to treat human immunodeficiency virus (HIV) infection and adverse drug reactions (ADRs) encountered predominantly in the liver, including hypersensitivity syndrome reactions, as well as throughout the gastrointestinal system, including the pancreas. Highly active antiretroviral therapy (HAART) has a positive influence on the quality of life and longevity in HIV patients, substantially reducing morbidity and mortality in this population. However, HAART produces a spectrum of ADRs. Alcohol consumption can interact with HAART as well as other pharmaceutical agents used for the prevention of opportunistic infections such as pneumonia and tuberculosis. Other coinfections that occur in HIV, such as hepatitis viruses B or C, cytomegalovirus, or herpes simplex virus, further complicate the etiology of HAART-induced ADRs. The aspect of liver pathology including liver structure and function has received little attention and deserves further evaluation. The materials used provide a data-supported approach. They are based on systematic review and analysis of recently published world literature (MedLine search) and the experience of the authors in the specified topic. We conclude that therapeutic and drug monitoring of ART, using laboratory identification of phenotypic susceptibilities, drug interactions with other medications, drug interactions with herbal medicines, and alcohol intake might enable a safer use of this medication.