Liver disease has recently been described as an important cause of morbidity and mortality in patients infected with human immunodeficiency virus(HIV). Liver test changes are useful surrogates of the burden of liver d...Liver disease has recently been described as an important cause of morbidity and mortality in patients infected with human immunodeficiency virus(HIV). Liver test changes are useful surrogates of the burden of liver disease. Previous studies have shown that transaminase elevations are frequent among these patients. The cause of those changes is harder to establish in HIV-patients. We present a 61-year-old caucasian male,diagnosed with HIV type 1 infection since 1998,under highly active antiretroviral treatment(HAART),with virological suppression and immunological recovery. He presented in a follow-up laboratory workup high values of transaminases,arthralgia at the hip joints and hepatomegaly. Liver function tests were normal. The antibodies to hepatitis viruses were negative. However,autoimmune study and liver biopsy were compatible with autoimmune hepatitis(AIH). The AIH is a rare di-agnosis in HIV-infected patients perhaps because the elevation of transaminases and changes in liver function tests are often associated to HAART or to other possible liver diseases,namely viral hepatitis and non-alcoholic steatohepatitis. The diagnosis may be underestimated. There are no specific recommendations available for the treatment of HIV-associated AIH although the immunosupression with slower tapering seems the most reasonable approach.展开更多
文摘Liver disease has recently been described as an important cause of morbidity and mortality in patients infected with human immunodeficiency virus(HIV). Liver test changes are useful surrogates of the burden of liver disease. Previous studies have shown that transaminase elevations are frequent among these patients. The cause of those changes is harder to establish in HIV-patients. We present a 61-year-old caucasian male,diagnosed with HIV type 1 infection since 1998,under highly active antiretroviral treatment(HAART),with virological suppression and immunological recovery. He presented in a follow-up laboratory workup high values of transaminases,arthralgia at the hip joints and hepatomegaly. Liver function tests were normal. The antibodies to hepatitis viruses were negative. However,autoimmune study and liver biopsy were compatible with autoimmune hepatitis(AIH). The AIH is a rare di-agnosis in HIV-infected patients perhaps because the elevation of transaminases and changes in liver function tests are often associated to HAART or to other possible liver diseases,namely viral hepatitis and non-alcoholic steatohepatitis. The diagnosis may be underestimated. There are no specific recommendations available for the treatment of HIV-associated AIH although the immunosupression with slower tapering seems the most reasonable approach.
