Utility Of Liver Biopsy In Hiv-Infected Patients Presenting With Febrile Illnesses And Inconclusive Evaluation

Abstract

Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIVinfected patients presenting with febrile illnesses and inconclusive initial investigative work up. Design: A retrospective descriptive study.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical investigation and management of pyrexia of unknown origin 2023

“…Of nine relevant studies on the use of liver biopsy in the investigation of PUO among people living with HIV, eight were single-centre observational studies [46][47][48][49][50][51][52][53]. The ninth was the comparison by Prego et al [45], discussed above, of mycobacterial blood culture, liver biopsy and bone marrow biopsy among 12 individuals in the pre-ART era.…”

“…The eight single-centre studies evaluated a total of 356 individuals with HIV and PUO, from settings across Europe, North America, East Africa and South East Asia, and were published between 1990 and 2015. Quality of evidence for individual studies was very low, but some results were similar across studies [46][47][48][49][50][51][52][53].…”

“…Four studies showed that mycobacterial infection was more frequently identified among those with raised alkaline phosphatase levels [46][47][48][49]. In one of these studies, conducted in Spain, in which the predominant diagnoses were TB and visceral leishmaniasis, liver biopsy was found to be helpful in the presence of hepatomegaly or splenomegaly and, for those with TB, in the presence of hepatomegaly and raised alkaline phosphatase [48].…”

“…Of nine relevant studies on the use of liver biopsy in the investigation of PUO among people living with HIV, eight were single‐centre observational studies [46–53]. The ninth was the comparison by Prego et al .…”