**42. References**


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256 Immunodeficiency

CCR5 antagonists.

**Author details** 

**42. References** 

Kerina Duri

since selective pressure could direct the virus to use less productive coreceptors, avoiding the progression of the disease. In addition leveraging new technologies capable of detecting low-level minority species may provide the most significant advances in ensuring that individuals with low levels of dual/mixed tropic virus are not inadvertently prescribed

*University of Zimbabwe, College of Health Sciences, Department of Immunology, Harare, Zimbabwe* 

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[2] Hoffman TL and Doms RW (1999). HIV-1 envelope determinants for cell tropism and

[3] Sundaravaradan V, Das SR, Ramakrishnan R, Sehgal S, Gopalan S, Ahmad N and Jameel S (2007). The role of HIV-1 subtype C V3 to C5 region in viral entry, coreceptor utilization and replication efficiency in primary T- lymphocytes and monocyte derived

[4] Johnston ER, Zijenah LS, Mutetwa S, Kantor R, Kittinunvorakoon C and Katzenstein DA (2003). High frequency of syncytium–inducing and CXCR4–Tropic viruses among human Immunodeficiency virus type 1 subtype C infected patients receiving

[5] Moyle GJ, Wildfire A Mandalia S. (2005) Epidemiology and predictive factors for

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[9] Huang W, Eshleman SH, Toma J, Stawiski E, Whitcomb JM (2007). Coreceptor tropism in human immunodeficiency virus type 1 subtype D: high prevalence of CXCR4 tropism and heterogeneous composition of viral population. J. Virol 81: 7885-7893).

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characterization of fractalkine receptor CX3CR1, which mediates both leukocyte migration and adhesion". *Cell* 91 (4): 521–30

**Chapter 12** 

© 2012 Joshi and Agarwal, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

**The Role of Liver Transplantation** 

In developed countries, the management and treatment of HIV-1 infection was revolutionised after the introduction of combined anti-viral therapy (cART) in 1996. The major outcome was the reduction of AIDS and AIDS-related deaths (1). Such was the success of cART, that now more than 50% of deaths in HIV positive patients on cART are not directly related to HIV infection or AIDS (1-3). The D:A:D (data collection on adverse events of anti-HIV drugs) study demonstrated that liver disease had become the commonest cause of a non-AIDS related death overtaking cardiovascular disease (2). Given the similar transmission routes, unsurprisingly nearly two-thirds of deaths were secondary to chronic hepatitis C virus (HCV) infection, 17% secondary to chronic hepatitis B virus (HBV) infection and 3% due drug-induced liver injury related to cART (2). Other liver-related aetiologies amongst HIV positive individuals include alcohol, non-alcohol related liver disease (NAFLD), hepatocellular carcinoma (HCC) (Table 1). HIV positive patients present with the same clinical sequelae of chronic liver disease as their HIV negative counterparts but tend to present at a younger age but with a markedly reduced survival rate after the first episode of decompensation (4). In HIV-positive patients with compensated cirrhosis an increased mortality rate is associated with age > 50 years, MELD score > 11 and poor control

One third of patients with HIV infection are co-infected with chronic HCV, and the majority of deaths in HIV-positive patients with ESLD can be attributable to HCV infection(6). HCV is transmitted via contaminated blood or blood products. At-risk groups include

and reproduction in any medium, provided the original work is properly cited.

**in HIV Positive Patients** 

Additional information is available at the end of the chapter

Deepak Joshi and Kosh Agarwal

http://dx.doi.org/10.5772/51556

**1.1. Burden of liver disease** 

**1. Introduction** 

of HIV disease (5).

**1.2. Viral aetiologies** 

