Natural history of AIDS related sclerosing cholangitis: a study of 20 cases.

Abstract

A case control study of AIDS related sclerosing cholangitis indicates that it has no overall influence on prognosis, but is responsible for a striking reversal of the usual inverse correlation of age and survival in HIV infection. Pain, the principal symptom, was controlled in surviving patients with analgesics alone. Twenty consecutive patients with AIDS related sclerosing cholangitis, defined from at least two characteristic lesions at endoscopic retrograde cholangiopancreatography, were followed for a minimum of 10 months or until death. Median age was 33-5 years (range 27-50). All had abdominal pain; 11 had diarrhoea. Alkaline phosphatase was >2X normal in 13, but the bilirubin was raised in only three. The median CD4 was 0*024X109/l (0.005-0.341). Thirteen had cryptosporidiosis, six had active cytomegalovirus, five had no gastrointestinal pathogen. Three patients are alive without AIDS related sclerosing cholangitis symptoms at 10, 11, and 21 months. Seventeen have died at median 7 (1-23) months. Cytomegalovirus therapy had no apparent influence. The initial CD4 was <0.11 in all those dying within six months, but correlation of CD4 with prognosis was otherwise poor. Controls, matched for age, CD4, and opportunistic infections had virtually identical overall outcome (median survival 7-5 months) and the expected worse prognosis with increasing age. Increasing age, however, appeared protective in AIDS related sclerosing cholangitis (r=+0.6; p<005): this is not explained by disproportionate degrees of immunosuppression, nor by opportunistic infections.

Autoimmune overlap syndromes

“…Indeed, fibro-obliterative cholangitis was identified in only 12% of liver biopsies from 60 patients with an established diagnosis of PSC. 18 Neither is this feature specific to PSC as it may be associated with a variety of vascular, 28 viral, 29 and neoplastic 30 causes of secondary sclerosing cholangitis. Atypical pANCA, the autoantibody most closely associated with PSC, is present in up to 85% of cases 25 and may also be detected in at least 5% of patients with PBC 31 as well as most patients with AIH.…”

Liver Function Profile Anomalies in HIV Seropositive Tuberculosis

“…This may be due to the degeneration of the connective tissue of the liver [29] and it may also be the result of the hepatobiliary obstruction that had occurred in the subjects. The structural abnormalities like papillary stenosis, sclerosing cholangitis, cholecystitis and a thickened gall bladder wall [30] in these HIV patients could be attributed to the TB like opportunistic infection [30,31].…”

Cryptosporidiosis - From Epidemiology to Treatment

“…Although not appearing to adversely affect survival, the disease can be a cause of significant pain (Forbes et al, 1993). In a Spanish study of 43 AIDS patients with chronic diarrhea due to Cryptosporidium infection, 8 patients (18.6%) were reported to have Cryptosporidium infection of the common bile duct (Lopez-Velez et al, 1995).…”