Hepatobiliary and Pancreatic Infections in AIDS: Part One

Abstract

Infections of the liver and biliary tract are common during the course of AIDS. A variety of viral, bacterial, fungal, and other opportunistic infections can present with hepatobiliary involvement as either the primary site of infection or secondary to a disseminated process. Coinfection with hepatitis B and C are particularly common due to the shared means of transmission of these viruses with HIV. The typical presenting features of hepatobiliary infections are right upper quadrant (RUQ) pain and abnormal liver function tests. Initial evaluation should include an RUQ ultrasonogram, which will usually identify abnormalities in the biliary tract and may demonstrate some parenchymal abnormalities as well. A liver biopsy is necessary to determine the etiology of focal hepatic lesions or opportunistic infections within hepatic parenchyma when other less invasive tests are negative or inconclusive. Special stains and culture techniques are required to identify specific organisms in the biopsy specimen. HIV-related biliary disorders include acalculous cholecystitis, which is a potentially serious condition requiring prompt recognition and gallbladder decompression. AIDS-cholangiopathy is a form of cholangitis involving the intra- and/or extrahepatic biliary tree. Endoscopic retrograde cholangio-pancreatography (ERCP) is the test of choice, demonstrating the stricturing, dilatation, and beading of bile ducts seen in this condition. Endoscopic sphincterotomy of the papilla of Vater may provide symptomatic relief for patients with papillary stenosis. Opportunistic infections of the pancreas have been reported. Evaluation should include a computerized tomogram of the abdomen and possible pancreatic tissue aspiration or biopsy. Management of pancreatitis is supportive.

Liver Disease in the HIV–Infected Individual

“…Of these, Mycobacterium avium complex (MAC) is the most common. It is usually characterized histologically by acid-fast bacilli-containing poorly formed granulomas, although mass lesions have been described [90, 91] . Patients often present with nausea, diarrhea, and abdominal pain.…”

“…Alkaline phosphatase is usually disproportionately increased [92] . Hepatic involvement of Mycobacterium tuberculosis , including liver abscesses, has been reported in approximately 8% of patients with extrapulmonary tuberculosis and HIV infection [91, 93] . CMV is one of the most common opportunistic infections involving the liver detected on autopsy of patients with advanced AIDS but rarely results in a clinical hepatitis [90, 92] .…”

Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth

“…Preliminary data suggest that HIV infection and ensuing inflammation may play a significant role in this process. HIV infection is associated with many hepatobiliary disorders, including hepatomegaly, steatosis and elevated serum liver enzymes[4–7]. There is evidence to suggest that HIV interacts directly with multiple liver cell types[8–17].…”

Viral infections of the biliary tract

“…Sixty percent of the cases can be attributed to infectious causes, while the remaining 40% have no identifiable cause. [10] Many infectious agents including Cytomegalovirus (CMV), Cryptosporidium , Campylobacter , Candida albicans , Klebsiella pneumoniae , Microsporidia , and Reovirus type 3, have been reported to cause cholangitis in AIDS patients. [1112] Cytomegalovirus and Cryptosporidium are the most frequently reported pathogens.…”