Evaluation of the histopathological hepatic lesions and opportunistic agents in Brazilian HIV patients

Pereira, Graziella Hanna; Yamagutti, Diva Carvalho Collarile; Mendonça, João Silva de

doi:10.1590/s0037-86822010000100001

Cited by 6 publications

(1 citation statement)

References 6 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Histopathology studies demonstrated a multiplicity of HIV associated disease in the liver, with aetiology differing widely in different population settings [6-10]. Despite this, jaundice has been regarded as infrequent in HIV [11].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature

Barr

Ramdial²

2012

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundThe development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI).Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) as a cause of liver disease in patients initiating HAART, which could also cause jaundice.Case presentationsWe report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART) for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa.All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in the other four.In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated – in addition to epithelioid histiocytes and Langhans giant cells – neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response.ConclusionIn this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be useful to clinicians in low resource settings dealing with this challenging presentation.

show abstract

Section: Discussionmentioning

confidence: 99%