title: Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV).
abstract: Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver diseases. We undertook a retrospective study of 501 HIV-seropositive patients to assess the yield of percutaneous liver biopsy. The most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). The most common biopsy-derived diagnosis was Mycobacterium avium complex (MAC), seen in 87 (17.4%) biopsies. Mycobacterium tuberculosis was found in 13 biopsies (2.6%). In 28 biopsies (5.6%) mycobacteria was seen, but speciation of the organism was not possible. Chronic active viral hepatitis was seen in 60 biopsies (12.0%). Opportunistic hepatic infection from other organisms was found in 14 biopsies (2.8%). The most common neoplasm was lymphoma, which was seen in 12 biopsies (2.4%). MAC infection of the liver was associated with elevated alkaline phosphatase (p = 0.01). Among patients with fever for 2 weeks after an extensive negative workup including bone marrow biopsy, 58.2% had a diagnosis by liver biopsy. Overall, 64.3% of liver biopsies yielded a histopathological diagnosis, 45.7% of which were potentially treatable. We could not evaluate whether liver biopsy had a positive effect on patient outcome and survival, nor did we attempt to prove that liver biopsy resulted in a change in treatment or a change in preprocedure clinical diagnosis. Thus, questions about the efficacy of liver biopsy cannot be answered. Liver biopsy may be a helpful diagnostic tool in HIV-positive patients with fever, liver test abnormalities or hepatomegaly.
authors.affiliation: New York University Medical Center, NY 10016, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Poles
authors.forename: D T
authors.initials: DT
authors.lastname: Dieterich
authors.forename: E D
authors.initials: ED
authors.lastname: Schwarz
authors.forename: E H
authors.initials: EH
authors.lastname: Weinshel
authors.forename: E A
authors.initials: EA
authors.lastname: Lew
authors.forename: R
authors.initials: R
authors.lastname: Lew
authors.forename: J V
authors.initials: JV
authors.lastname: Scholes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000473:pathology; D006679:HIV Seropositivity / Q000150:complications; D015497:HIV-1; D006529:Hepatomegaly; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies