title: Human immunodeficiency virus infection and autoimmune hepatitis during highly active anti-retroviral treatment: a case report and review of the literature.
abstract: BACKGROUND
  The emergence of hepatic injury in patients with human immunodeficiency virus infection during highly active therapy presents a diagnostic dilemma. It may represent treatment side effects or autoimmune disorders, such as autoimmune hepatitis, emerging during immune restoration.
  
  
  METHODS
  We present the case of a 42-year-old African-American woman with human immunodeficiency virus infection who presented to our emergency department with severe abdominal pain and was found to have autoimmune hepatitis. A review of the literature revealed 12 reported cases of autoimmune hepatitis in adults with human immunodeficiency virus infection, only three of whom were diagnosed after highly active anti-retroviral treatment was initiated. All four cases (including our patient) were women, and one had a history of other autoimmune disorders. In our patient (the one patient case we are reporting), a liver biopsy revealed interface hepatitis, necrosis with lymphocytes and plasma cell infiltrates and variable degrees of fibrosis. All four cases required treatment with corticosteroids and/or other immune modulating agents and responded well.
  
  
  CONCLUSIONS
  Our review suggests that autoimmune hepatitis is a rare disorder which usually develops in women about six to eight months after commencing highly active anti-retroviral treatment during the recovery of CD4 lymphocytes. It represents either re-emergence of a pre-existing condition that was unrecognized or a de novo manifestation during immune reconstitution.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, St John Hospital & Medical Center, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, MI 48236, USA. Riad.Khatib@stjohn.org.
authors.forename: Hanady
authors.initials: H
authors.lastname: Daas
authors.forename: Riad
authors.initials: R
authors.lastname: Khatib
authors.forename: Haitham
authors.initials: H
authors.lastname: Nasser
authors.forename: Farah
authors.initials: F
authors.lastname: Kamran
authors.forename: Martha
authors.initials: M
authors.lastname: Higgins
authors.forename: Louis
authors.initials: L
authors.lastname: Saravolatz