Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults.
Although Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults.



Retrospective study of patients diagnosed with hepatic TB from 2005-2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa.



Among twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/μl (inter-quartile range 27-107 cells/μl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322-1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235-736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died.



In our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.
Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. gounder@ukzn.ac.za.|Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa. gounder@ukzn.ac.za.
Lilishia
0000-0003-1060-9170
L
Gounder
Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa.
Pravikrishnen
P
Moodley
Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA.|Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Paul K
PK
Drain
University of Maryland School of Medicine, Baltimore, USA.
Andrew J
AJ
Hickey
Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.|King Edward VIII Hospital, Durban, South Africa.
Mahomed-Yunus S
MS
Moosa
D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D013019:South Africa; D014386:Tuberculosis, Hepatic / Q000150:complications*; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications; D014397:Tuberculosis, Pulmonary / Q000150:complications; D055815:Young Adult
Granuloma; HIV; Liver; South Africa; TB