Hepatic disease in patients with the acquired immune deficiency syndrome (AIDS)

Abstract

The spectrum of liver disease in patients with acquired immune deficiency syndrome (AIDS) and the clinical impact of diagnostic percutaneous liver biopsy in this population were evaluated by a retrospective review of hepatic histology, clinical features and laboratory data in 85 patients (26 biopsies, 59 autopsies). Only 1 (3.8%) biopsy and 9 (15%) postmortem livers were histologically normal. Macrosteatosis and nonspecific portal inflammation were the most common histologic abnormalities. Intrahepatic AIDS-specific opportunistic infections or malignancies were detected in 42% of both biopsy and autopsy groups, with Mycobacterium avium-intracellulare the most frequent pathogen seen. Kaposi's sarcoma, although not detected on biopsy, was the most common postmortem AIDS-related hepatic finding. Intrahepatic lymphoma, cytomegalovirus hepatitis and hepatic mycoses were less frequently observed. In general, hepatic involvement represented part of a previously diagnosed, widely disseminated disease process, and liver biopsy led to new AIDS-specific diagnoses in only two patients. We conclude that while liver biopsy is a useful diagnostic tool in selected patients with AIDS, the information provided by biopsy rarely influences therapy or leads to improved survival.

Acute and Chronic T Cell Dynamics in the Livers of Simian Immunodeficiency Virus-Infected Macaques

“…Hepatitis associated with HIV-1 is being seen with increasing frequency as this virus becomes more prevalent in diverse human populations. Up to three-quarters of patients with AIDS have serious liver abnormalities (13,21). Secondary infections with hepatitis B and/or C viruses are a major cause of morbidity and mortality in this population (3).…”

Pathology of AIDS-Related Liver Disease

“…Liv er enlargement may be due to steatosis or infiltration by granulomas, Kaposi's sarcoma or lymphoma. Serum liver test abnormalities are found in 80% or more of AIDS patients [3, 4,11] and fall into three major categories: (1) isolated elevation of serum alkaline phospha tase (seen in granulomatous liver disease due to M. avium-intracellulare and other patho gens, cytomegalovirus infection, infiltrating lymphoma or Kaposi's sarcoma), (2) elevated serum alkaline phosphatase with bilirubin (seen in sepsis or the multimicrobial scleros ing cholangitis-like syndrome) and (3) mild elevations of serum aminotransferases (due to concomitant chronic viral hepatitis B, C or D). Liver tests are often only twice elevated [3], although six-to tenfold elevations of alka line phosphatase may be seen.…”

Lactic Acidosis in the Setting of Antiretroviral Therapy for the Acquired Immunodeficiency Syndrome

“…The vast majority of patients on ART do not develop lactic acidosis, although macrosteatosis and nonspecific portal inflammation are commonly seen on liver biopsy [19]. Fortgang et al [7] in a retrospective study of 1,836 patients in an outpatient HIV clinic, discovered only 2 patients, both on zidovudine, with fatal abnormal liver function in association with hepatomegaly and diffuse fatty infiltration of the liver.…”