Hepatobiliary diseases in patients with human immunodeficiency virus (HIV) treated with non highly active anti-retroviral therapy: frequency and clinical manifestations.
OBJECTIVE
To evaluate the frequency of hepatobiliary diseases and the clinical manifestations in patients with HIV treated with non highly active anti-retroviral therapy.


METHODS
Seven hundred clinical records of patients with HIV infection who entered the Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán from January 1987 to December 1996 were reviewed. All patients with alterations associated to hepatobiliary disease and/or liver function tests derangement throughout the clinical development of their disease were included. Demographic variables, date of diagnosis and clinical stage of the disease, as well as the presentation forms, diagnostic approach and image studies were analyzed.


RESULTS
One hundred and sixty-one patients (22.8%) with hepatobiliary manifestations were found. The average time between the HIV diagnosis and the presentation of hepatic manifestations was 2-12 years. The majority of patients 124/161 (77%) did not show clinical signs of liver damage. The diagnostic suspicion was established by the presence of alkaline phosphatase above normal in 29% and alkaline phosphatase plus aminotransferases above normal in 45%. Hepatomegaly and jaundice were present in 18% and 4% of the patients, respectively. The most frequent ultrasonographic diagnosis were hepatomegaly (40%) and steatosis (30%). Liver biopsies were performed in 85 (51%) of the patients. The main histologic diagnoses were granulomatous hepatitis (29%), steatosis plus granulomatous hepatitis (19.5%), and steatosis alone (14.6%). Microorganisms were isolated in 27.9% being the most frequent Mycobacterium tuberculosis (26.6%), Histoplasma capsulatum (20%), Cytomegalovirus (13.3%), and Mycobacterium avium intracellulare (11%). The HBsAg was positive in 21 of the 69 patients (30.4%).


CONCLUSIONS
The clinical presentation was asymptomatic in most of cases and the main etiology could be explained by the presence of associated infections, granulomatoses and liver steatosis.
Lizardi-Cervera
Javier
J
Clínica de Gasroenterología, Fundación Clínica Médica Sur. jlizardi@medicasur.org.mx
Soto Ramírez
Luis E
LE
Poo
Jorge Luis
JL
Uribe
Misael
M
D023241:Antiretroviral Therapy, Highly Active; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006658:Histoplasma; D006660:Histoplasmosis / Q000453:epidemiology; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D009164:Mycobacterium Infections / Q000453:epidemiology; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D014463:Ultrasonography