Autoimmune hepatitis in an HIV-infected patient: an intriguing association

Abstract

Abnormal levels of liver enzymes are common in HIV-infected patients and may be caused by multiple factors, including co-infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) infection and in the majority of cases by antiretroviral drug-related liver injury. This report, however, describes a patient with HIV infection and abnormal liver function tests where further diagnostics revealed concomitant autoimmune hepatitis (AIH). The association of immune dysfunction in patients with HIV infection/AIDS and the development of autoimmune diseases is intriguing. The precise mechanism causing the emergence or unmasking of autoimmune conditions in HIV infection remains unclear, but it is important to demonstrate that autoimmune diseases do occur in HIV-infected patients. Therefore, clinicians should include AIH in the differential diagnosis of increased liver enzymes when there is no improvement despite changing antiretroviral therapy.

Pathogen Infection as a Possible Cause for Autoimmune Hepatitis

“…A 52-year-old man who was diagnosed with HIV infection developed ANA, hypergammaglobulinemia, and elevated serum aminotransferase levels. In addition, a liver biopsy revealed the classical features of chronic interface hepatitis with plasmacytic infiltrates [83]. In contrast to the case report by Al Hamoudi, diagnosis of HIV infection and AIH were not in close proximity but were separated by 7 years.…”

“…The patient proved serum-negative for antibodies to HAV, HCV, EBV, and CMV and further HBV and HCV RNA were not detectable at that time either. However, the patient had also a medical history of a past recovery from HBV infection [83]. Thus, a direct association between HIV infection and AIH is far from proof.…”

“…Another case report links AIH to human immunodeficiency virus (HIV) infection [83]. A 52-year-old man who was diagnosed with HIV infection developed ANA, hypergammaglobulinemia, and elevated serum aminotransferase levels.…”

Autoimmune hepatitis: a manifestation of immune reconstitution inflammatory syndrome in HIV infected patients?

“…[23] Review of literature identified six reports describing eight cases with immune reconstitution-related autoimmune hepatitis (IRRAH). [11][12][13][14][15][16] These patients had no prior history of AIH or abnormal liver enzymes. They were HIV positive patients who developed transaminase abnormalities months to years after starting HAART (Table 2).…”

“…[10] These include jaundice, fatigue, abnormal liver enzymes, anti-nuclear antibodies (ANA), anti-smooth muscle antibody (ASMA), and anti-liver kidney microsomal antibody (ALKM). AIH has been rarely reported after ARV initiation in HIV-infected patients [11][12][13][14][15][16] and these are the first cases to be reported from Africa.…”