Cryptogenic liver disease in HIV-seropositive men.
OBJECTIVE
In the era of highly active antiretroviral therapy (HAART), liver disease has become a leading cause of morbidity and mortality in HIV-seropositive individuals. Although liver disease is commonly caused by viral co-infection, it has also been described in patients without viral hepatitis. In this study, we determined clinical factors associated with the development of cryptogenic liver disease in HIV-infected individuals.


METHODS
HIV-seropositive and -seronegative patients undergoing evaluation for liver transplantation were selected if they met clinical criteria for cryptogenic liver disease. Clinical data were collected retrospectively, and radiological and histological data were reviewed separately.


RESULTS
Nine HIV-seropositive individuals were compared with 41 HIV-seronegative patients with cryptogenic liver disease. Only one HIV-seropositive patient (11%) had cirrhosis, compared to 39 HIV-seronegative patients (93%) (P<0.001). Three HIV-infected patients (33%) had histological evidence of nodular regenerative hyperplasia. HIV-seropositive patients had significantly lower body mass indices, and lower Child-Pugh-Turcotte and Model for Endstage Liver Disease scores than HIV-seronegative patients (P<0.05).


CONCLUSIONS
Advanced cryptogenic liver disease in HIV-infected patients is infrequently caused by cirrhosis, and more frequently by nodular regenerative hyperplasia. This disease entity may become more common in the HAART era, and may contribute to an increased morbidity in HIV-infected individuals.
Dinh
M H
MH
Division of Infectious Diseases, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. m-dinh@northwestern.edu
Stosor
V
V
Rao
S M
SM
Miller
F H
FH
Green
R M
RM
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D002908:Chronic Disease; D020518:Focal Nodular Hyperplasia / Q000209:etiology* / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors
D019380:Anti-HIV Agents