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Hepatitis in HIV

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Hepatitis in HIV, AIDS Cholangiopathy

  • 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. Sclerosing Cholangitis syndrome
    1. Cytomegalovirus
    2. Cryptosporidium
  4. Viral Hepatitis (accelerated course to liver failure)
    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
  5. Cholestatic hepatitis (consider occult infection)
    1. Mycobacterium Avium Complex (MAC)
    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]