The spectrum of liver diseases in HIV infected individuals at an HIV treatment clinic in Kampala, Uganda.
BACKGROUND
Liver diseases are common in patients with HIV due to viral hepatitis B and C co-infections, opportunistic infections or malignancies, antiretroviral drugs and drugs for opportunistic infections.


OBJECTIVE
To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala, Uganda.


METHODS
Consecutive patients presenting with jaundice, right upper quadrant pain with fever or malaise, ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease.


RESULTS
Seventy-seven consecutive patients were recruited over an eleven month period. Of these, 23 (30%) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61%) patients with drug-induced liver disease presented with jaundice, all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15%) patients while anti-hepatitis C antibody was reactive in only 2 (3%). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9%) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease, AIDS cholangiopathy, hepatocellular carcinoma, schistosomiasis, haemangioma and hepatic adenoma. Twelve (16%) patients died during follow-up of which 7 (9%) died because of liver disease.


CONCLUSIONS
Drug history, liver enzyme studies, ultrasound, and hepatitis B and C investigations identified the probable etiology in 60 (78%) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease.
Infectious Diseases Institute, Kampala, Uganda. pocama@idi.co.ug
Ponsiano
P
Ocama
Michael
M
Katwere
Theresa
T
Piloya
Jordan
J
Feld
Kenneth C
KC
Opio
Andrew
A
Kambugu
Elly
E
Katabira
David
D
Thomas
Robert
R
Colebunders
Allan
A
Ronald
D019380:Anti-HIV Agents / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007538:Isoniazid / Q000009:adverse effects*; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D019829:Nevirapine / Q000009:adverse effects*; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology; D014454:Uganda
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; D007538:Isoniazid