GI

Hepatitis in HIV

search

Hepatitis in HIV, AIDS Cholangiopathy, HIV-related Sclerosing Cholangitis, Hepatobiliary Manifestations of HIV, HIV Related Liver Disease, Hepatic Disorders in 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. Comorbid Viral Hepatitis (Transaminitis; accelerated course to liver failure in HIV patients)
    1. Hepatitis BVirus
    2. Hepatitis CVirus
      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
  6. Hepatotoxicity from Antiretroviral therapy
    1. See Hepatotoxin
    2. Stavudine
    3. Integrase Inhibitors (increase Steatohepatitis)
    4. Atazanavir (benign increase in Indirect Bilirubin)
  • 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
  3. Treat Viral Hepatitis coinfections
    1. See Hepatitis C Antiviral Regimen (treat early in course)
    2. See Chronic Hepatitis B Infection (treat HIV with medications that also cover Hepatitis BVirus)
  • Complications
  1. Hepatic Fibrosis
  2. Cirrhosis and liver failure
  • Prevention
  1. See Nonalcoholic Fatty Liver
  2. Hepatitis A Vaccine
  3. Hepatitis B Vaccine
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]