title: Tuberculosis and hepatic steatosis are prevalent liver pathology findings among HIV-infected patients in South Africa.
abstract: Liver disease epidemiology in sub-Saharan Africa has shifted as a result of HIV and the increased use of antiretroviral therapy leading to a need for updated data on common causes of liver disease. We retrospectively reviewed records from all hospitalized patients who had liver biopsy at a single hospital in South Africa from 2001 to 2009 and compared diagnosis by HIV status. During the period of study 262 patients had liver biopsy, 108 (41%) were HIV-infected, 25 (10%) were HIV-sero-negative, and 129 (49%) had unknown or unrecorded HIV status. Overall 81% of biopsies provided additional diagnostic data. Malignancy was the most common finding reported on 56 (21%) biopsies followed by granuloma or TB, hepatic steatosis, and fibrosis or cirrhosis. HIV-infected patients were more likely to have granulomas and steatosis. Half of patients with granulomas were already on TB treatment, suggesting paradoxical reactions or drug induced liver injury may have been important causes of liver inflammation among these patients. We note that TB, paradoxical reactions during TB treatment, possible drug induced liver injury, and hepatic steatosis are important causes of liver pathology among HIV-infected hospitalized patients with unclear etiology of liver disease after initial assessment. Among HIV sero-negative patients, malignancy was the major cause of liver disease. Our findings re-enforce the importance of TB as a diagnosis among HIV-infected individuals.
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America.
authors: Christopher J
authors: CJ
authors: Hoffmann
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America.
authors: Jennifer D
authors: JD
authors: Hoffmann
authors: University of Pittsburgh School of Medicine, Pittsburgh, United States of America.
authors: Caroline
authors: C
authors: Kensler
authors: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors: Martin
authors: M
authors: van der Watt
authors: Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
authors: Tanvier
authors: T
authors: Omar
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America.
authors: Richard E
authors: RE
authors: Chaisson
authors: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors: Neil A
authors: NA
authors: Martinson
authors: Department of Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Klerksdorp, South Africa.
authors: Ebrahim
authors: E
authors: Variava
mesh_terms: D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology / Q000821:virology; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D005260:Female; D006099:Granuloma / Q000473:pathology / Q000821:virology; D015658:HIV Infections / Q000473:pathology* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology