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Hepatitis in HIV

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Hepatitis in HIV, AIDS Cholangiopathy, HIV-related Sclerosing Cholangitis, Hepatobiliary Manifestations of HIV

  • See Also
  1. Hepatitis
  2. Gastrointestinal Manifestations of HIV
  3. HIV Complications
  • Epidemiology
  1. Hepatomegaly occurs in 50% of AIDS patients
  • Differential Diagnosis
  1. Diffuse hepatocellular disease
  2. Granulomatous hepatitis
  3. Viral Hepatitis (Transaminitis; accelerated course to liver failure in HIV patients)
    1. Hepatitis B
    2. Hepatitis C
      1. Strongly consider Hepatitis C Antiviral Regimen (90% sustained response)
      2. http://www.hcvguidelines.org/unique-populations/hiv-hcv
  4. Sclerosing Cholangitis syndrome
    1. Cytomegalovirus (associated with infectious Pancreatitis)
    2. Cryptosporidium
  5. Cholestatic hepatitis (consider occult infection)
    1. Mycobacterium Avium Complex (MAC)
      1. Associated with infectious Pancreatitis
      2. Lab findings include increased Alkaline Phosphatase, Lactate Dehydrogenase (LDH) and Anemia
    2. Mycobacterium tuberculosis
    3. Histoplasmosis
    4. Coccidioidomycosis
    5. Cryptococcus
    6. Kaposi's Sarcoma
    7. Non-Hodgkin's Lymphoma
    8. HIV-associated Peliosis Hepatitis
    9. Drug induced cholestasis
    10. Steatosis (macrovesicular and microvesicular)
      1. Nonalcoholic Fatty Liver
      2. Alcoholic Fatty Liver
  • Labs
  1. Viral Hepatitis serologies
  • Imaging
  1. Right Upper Quadrant Ultrasound
  2. CT Abdomen and Pelvis
  3. MRCP or ERCP (indicated for signs of biliary obstruction)
  • Management
  1. Avoid Hepatotoxins (e.g. Alcohol)
  2. Manage comorbidities
    1. Alcohol Abuse
    2. Obesity
    3. Dyslipidemia
    4. Insulin Resistance
    5. Diabetes Mellitus
  • Prevention
  1. Hepatitis A Vaccine
  2. Hepatitis B Vaccine
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]