Hepatotoxicity of antiviral agents

Antiretroviral drugs, targeting the human immune deficiency virus, are the antivirals that more often cause drug-induced liver injury (DILI). DILI secondary to antiretroviral use is mostly asymptomatic and manifested only by elevation of liver enzymes. However, there are specific DILI syndromes associated with antiretroviral therapy: hypersensitivity reactions, lactic acidosis with hepatic steatosis, decompensation of cirrhotic liver, noncirrhotic portal hypertension, and nonalcoholic steatohepatitis. Although the exact pathogenic mechanisms for these forms of DILI may not be fully understood, risk factors have been recognized. Interferon, used for the treatment of hepatitis C and B viruses, can also cause decompensation of a cirrhotic liver. In addition, antivirals targeting Herpesviridae can cause liver enzyme elevations, albeit infrequently, and have occasionally been associated with liver failure.