THE LIVER IN AIDS

Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.

THE LIVER IN AIDS

AIDS, Acquired Immune Deficiency Syndrome, and other Manifestations of HIV Infection. Wormser GP et al, eds. Park Ridge, NJ, Noyes Publications, p. 767-82, 1987.. Unique Identifier : AIDSLINE ICDB/88647011
Lebovics E; Dworkin BM; Dept. of Medicine, New York Medical Coll., Valhalla, NY

Abstract: Patients (pts) with acquired immune deficiency syndrome (AIDS) commonly have clinical and histologic hepatic abnormalities, yet human immunodeficiency virus (HIV) infection itself does not appear to have direct effects upon the liver. The recognized liver involvement in AIDS pts relates to (1) coincident hepatotropic virus exposure; (2) complications--infectious, malignant, or iatrogenic--of the immunodeficiency state; or (3) nonspecific changes associated with chronic debilitating illness. Markers of past hepatitis B virus (HBV) exposure, namely hepatitis B surface antibody or hepatitis B core antibody, are found in approx 90% of AIDS pts. Immunosuppressed hosts generally tolerate HBV replication without a significant inflammatory response. Non-AIDS homosexuals with chronic hepatitis B respond less well to antiviral therapy, perhaps due to a blunted immune response to HBV. Hepatologic consultation is usually requested for AIDS pts to assist in the evaluation of unexplained fever, particularly when accompanied by hepatomegaly or abnormal liver biochemical tests. In the authors' experience, the yield of liver biopsy in providing a diagnosis of infectious disease is about 25%. The most commonly diagnosed hepatic infection in AIDS (exclusive of HBV) is due to Mycobacterium avium-intracellulare. Hepatic neoplasms in AIDS are Kaposi's sarcoma and malignant lymphoma. During the course of their illness, AIDS pts are iatrogenically exposed to numerous medications that are potential hepatotoxins. The most common histopathologic feature in liver biopsy of AIDS pts is macrovesicular steatosis. The authors recommend that liver biopsy be performed in AIDS pts with unexplained fever or chronic significant abnormalities of liver biochemical tests in whom less invasive evaluations fail to yield a diagnosis. Fears that HBV vaccine can transmit HIV have limited the use of the HBV vaccine. Extensive data have revealed no rational basis for such concerns. (91 Refs)

Keywords: Acquired Immunodeficiency Syndrome/*PATHOLOGY Hepatitis B/PATHOLOGY Hepatitis, Toxic/PATHOLOGY Hepatitis, Viral, Human/*PATHOLOGY Human Liver/PATHOLOGY Liver Neoplasms/*PATHOLOGY Opportunistic Infections/PATHOLOGY MONOGRAPH REVIEW, TUTORIAL REVIEW

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