Autoimmune hepatitis and HIV infection

Zoboli, Fabio; Ripamonti, Diego; Benatti, Simone; Comi, Laura; Rizzi, Marco

doi:10.1097/qad.0000000000001608

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…We searched PubMed database for relevant English literature with the search terms of “Autoimmune hepatitis” and “human immunodeficiency virus”, “Acquired Immunodeficiency syndrome” and identified 14 case reports/series of 35 patients with the concomitant diagnosis of AIH and HIV only without any coinfection (Table 1). In these previous reported cases/series, the range of CD4 count at the time of AIH diagnosis was between 174 and 1011 cells/mm3 with a viral load between undetectable and 27,000 IU/ml [2–15]. Our patient's CD4 count was just 11 cells/mm3 and viral load was 64,000 IU/ml at the time of AIH diagnosis.…”

Section: Discussionmentioning

confidence: 47%

Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature

Roussel

Pandit

Jordan

et al. 2019

Case Reports in Hepatology

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The common causes of abnormal liver chemistries in human immunodeficiency virus (HIV) infected patients are multifactorial. Diagnosis of autoimmune hepatitis (AIH) in HIV infected patients is intriguing but data is scarce. Unmasking of AIH during immune reconstitution in HIV patients after starting antiretroviral therapy is reported but not with advanced acquired immunodeficiency syndrome (AIDS). Here we present a fascinating case of 32-year-old African-American man with advanced AIDS who presented with elevated transaminases. He was diagnosed with AIH before starting antiretroviral therapy and successfully treated with prednisolone and azathioprine with antiretroviral therapy despite very low CD4 count.

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Section: Discussionmentioning

confidence: 47%

Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature

Roussel

Pandit

Jordan

et al. 2019

Case Reports in Hepatology

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“…In HIV-infected individuals, elevated liver enzymes are typically associated with chronic viral hepatitis, infiltrative liver disease, hepatic steatosis, drug-induced liver damage, and AIDS cholangiopathy. Given the nature of HIV infection-related immunosuppression, autoimmune diseases are not frequently considered in this population, which may have a major effect on the management and prognosis of these disorders [ 23 ]. Therefore, the differential diagnosis of elevated liver enzymes should include AIH, which is an unusual but potentially treatable clinical entity in HIV-infected individuals.…”

Section: Discussionmentioning

confidence: 99%

The demographics of autoimmune hepatitis in human immunodeficiency virus-infected patients: a United States cross-sectional study

Saleem¹,

Inayat²,

Khan³

et al. 2023

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Introduction Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver with increasing global prevalence. However, no epidemiological data exist for AIH in human immunodeficiency virus (HIV)-infected patients. Aim To determine the demographics and comorbid conditions associated with AIH among HIV-infected individuals in the United States. Material and methods The United States National Inpatient Sample database was used to identify HIV hospital encounters in 2012–2014. The encounters were then classified into 2 groups based on a concomitant primary diagnosis of AIH. Primary outcomes included the demographics and comorbid conditions of AIH among HIV-infected patients. Secondary outcomes assessed the independent predictors of AIH. Results A total of 48,3310 patients with an HIV diagnosis were included. The estimated AIH prevalence was 52.8/100,000 HIV hospital encounters. The female gender was more likely to have AIH with an odds ratio (OR) of 1.82; 95% confidence interval (CI) 1.42–2.32, p < 0.0001. The age intervals of 35–50 and 51–65 years had higher odds of AIH 110 (43.1%) and 115 (45.1%) with OR = 1.30; 95% CI: 1.02–1.67, p = 0.03 and OR = 1.34; 95% CI: 1.05–1.71, p = 0.02, respectively. African American and Hispanic races were more commonly affected. Moreover, HIV-infected patients with AIH had a higher risk of having elevated transaminases, long-term steroid use, rheumatoid arthritis, and ulcerative colitis. Conclusions This study illustrates that the estimated prevalence of AIH in HIV-infected patients in the United States is 52.8/100,000. AIH in HIV-positive individuals has a predilection for the female gender and African American and Hispanic races, and shows a higher correlation with rheumatoid arthritis and ulcerative colitis.

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“…Given the nature of HIV infection and its effect on the immune system, autoimmune diseases have been infrequently described in such patient populations and even less are cases describing HIV patients with diagnosis of AIH, which can have significant consequences on its management and prognosis. [2]…”

Section: Discussionmentioning

confidence: 99%

“…Although it is controversial to start patients with chronic HIV on immunosuppressive therapy given the risk of opportunistic infection, worsening of HIV status, or increasing risk of development of malignancies as shown by previous studies that reported increase in Kaposi sarcoma in HIV patients on immunosuppressive drugs, [16,15] it is still recommended to start immunosuppressive treatment to achieve remission and prevent disease progression. [2,3,19,20]…”

Section: Discussionmentioning

confidence: 99%

Autoimmune hepatitis in patients with human immunodeficiency virus infection

et al. 2019

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Background:Liver disease in patients with HIV is common and typically has complex and multifactorial presentations that represent a major cause of morbidity and mortality. Autoimmune hepatitis (AIH) is rarely reported in patient with HIV and the disease course and clinical outcomes for treatment have not been well characterized. We are aiming to determine the patient characteristics, disease prevalence, and treatment outcomes from published articles of patients with HIV and AIH.Method:A systematic search of PubMed, Web of Science, and Google Scholar through February 20th, 2019 identified 15 studies that reported the outcomes of AIH in patients with HIV. Because of the small sample sizes and skewed distributions, resampling tests of mean differences using permutation distributions (MAXn = 10,000 permutations) were utilized; analyses were performed using R (v. 3.5.1). Categorical differences were calculated using Fisher exact test for odds ratio = 1 (equal odds), and Cramer V was calculated for effect size; analyses were completed in SPSS (v. 25).Results:By reviewing 15 studies reporting a total of 35 patients with AIH and HIV, male patients were found to have significantly higher aspartate transaminase and alanine transaminase levels at time of diagnosis. No other significant findings identified. The CD4 count and viral load did not show significant correlation with AIH diagnosis or its prognosis. All patients but one who presented with severe immune deficiency and responded to highly active anti-retroviral therapy received immunosuppressive treatment without side effects and achieved remission except 2 lost to follow-up and 3 expired.Conclusion:Although rare, but AIH can develop in patients with HIV and physicians should consider it in the differential diagnosis for HIV patients presented with abnormal liver function tests, especially after excluding hepatitis C virus and drug-induced liver injury.Patients with immune deficiency disorders who present with AIH can be treated safely with steroid either as monotherapy or in combination with another immune suppressant therapy.

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Autoimmune hepatitis and HIV infection

Cited by 6 publications

References 24 publications

Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature

Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature

The demographics of autoimmune hepatitis in human immunodeficiency virus-infected patients: a United States cross-sectional study

Autoimmune hepatitis in patients with human immunodeficiency virus infection

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