HIV and LIVER

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HIV and LIVER
Dr.Bujji Babu
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HIV LIVER
LIVER IS THE COMMONEST SITE OF DISEASE IN
PATIENTS OF HIV INFECTION SYMPTOMS OF
HEPATOBILIARY DISEASE AND / OR BIOCHEMICAL
ABNORMALITIES OCCUR IN THE MAJORITY OF PATIENTS
WITH HIV DISEASE 80 HAVE ABNORMAL LFT AT SOME
POINT DURING THE COURSE OF HIV DISEASE 61
HAVE gt ALT 51 ALPHOS LIVER DISEASE IS THE
LEADING CAUSE OF DEATH

ClinInfDis 2001

J Acq Immun 2001
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HIV LIVER
HEPATIC INVOLVEMENT BY HIV OPPERTUNISTIC
INFECTIONS OF LIVER IN HIV HIV RELATED BILIARY
TRACT DISEASE COINFECTION OF DISEASES IN
TROPICS DRUG INDUCED LIVER DISEASE
(HAART) LIVER NEOPLASMS IN HIV
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HIV HEPATITIS
RECOGNIZED AS DISTINCT CLINICAL ENTITIY DIRECT
VIRAL INVOLVEMENT NO SPECIFIC CLINICAL
PATTERN DEMO OF HIV MESSENGER RNA IN
HEPATOCYTES DIAGNOSIS MANAGEMENT
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HIV-LIVER INFECTIONS
BACTERIAL MYCOBACTERIAL my av
int(MAC) my tub FUNGAL
Crypto Histo Coccoid
Sporoth PROTOZOA Amoebic
Leishmania
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HIV- LIVER -TUBERCULOSIS
Late event in the natural history MAC-38 Poorly
formed granuloma/76 AFB Culture diagnostic MT
occurs early Well formed granuloma Liver abscess/
portal adenopathy Often aggressive clinical
course Therapy Anti microbial sensitivity Long
term outcome-? Drug induced toxicity
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HIVFUNGAL INFECTIONS
As a part of disseminated disease Crypto
associated meningeal disease Candidiasis
multiple microabsces splenic ab HistoplasmPUO.
round oval budding
yeast Coccoido Pulm involvement/liver
granuloma Liver Bx/ FNAC Diagnostic Specific
therapy
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HIV PROTOZOAL
Pneumocystis carnii pulmonary
liver(most common ext pulm) Liver Bx nodules.
Foamy eosinophilic exudates Amoebic liver
abscess
Ind j GE 1999
J CliGE 2001
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HIV VIRAL INFECTIONS
MANY VIRAL INFECTIONS HEP-B HEP-C MOST
IMPORTANT (40) PROPHYLAXIS AGAINST HEP B
WITH VACCINE
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HIV- INFECTIONS
Ind J GE 1999 74 patients 45
alcoholics 81 HBV 29 ANTI HCV 5Hep
Tuberculosis 2 Liver abscess
MedScin Monit 2001
SouthEastAsianJ TropMed
2000 117 cases Crypt 21.4 Tub --16.2 CMV
5.1 Nno secific-49.6
2001
48.8 HEP .B 56.8 HEP.C
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HIV- NEOPLASMS
VISCERAL KAPOSIS SARCOMA/ 33-40 METS NON
HODGKINS LYMPHOMA (EBV) often correlates
with CD4 counts Aggressive Poor prognosis Median
survival about 6 mths HAART THERAPY REDUCED
INCIDENCE Int J
Can2003
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HIVBILIARY INVOLVEMENT
NON HIV RELATED BILIARY CONDITIONS
Biliary Calculi/CBD
diseases ACALCULOUS CHOLECYSTITIS
Associated with low CD4
US diagnostic
CMV infection
vasculitis/sec
infection HIV CHOLANGIOPATHY
Specific entity
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HIV CHOLANGIOPATHY
Middle aged RUQ pain alphos Dilated biliary
tract Distal CBD tapering Biopsy nonspecific
CMV/CRYPTO
Paillary stenosis----------------- 15 Sclerosing
cholangitis alone----20 Papillry
stenScleroCholan --- 50 Long Ext Bile duct
stricture---- 15 (AmJnMed1989)
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HIV- CHOLANGIOPATHY
PATHOGENISIS HIV INFECTION MULTIPLE
INFECTIONS DIARRHOEABILIARY
(ULCERATIVE COLITIS) UNIQUE HLA HAPLOTYPE
ASYMPTOMATIC 12/26 ? SIGNIFICANCE
SPHINCTEROTAMY ? BENEFIT
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HIV- ANTIVIRAL DRUGS---HAART
PROTEASE INHIBITORS Indinavir Nelfinavir Amprenav
ir Ritanavir Saquinavir Lopinavir ritonovir
NUCLEOSIDE REVERSE TRANSCRIPTASE
INHIBITORS
Zidovudine Didanosine Lamivudine Stavudine Zalcit
abine Abcavir NONNUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS
Delaviridine Efavirenz Nevirapine
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HIV-ANTIVIRAL DRUG TOXICITY

• 6 TO 10 CHOLESTASIS
• AC LIVER FAILURE
• POTENTIAL MITOCHONDRIAL TOXICITY
• TOXICITY TAKES 6Months
• NNRTI DRUGS CAUSE IMMUNE MEDIATED
• DURING PREGNANCY

DRUG INTERACTIONS NNRTIPI INTERACT-
P450 ASSOCITED ANTIBIOTICS COINFECTION WITH VIRAL
HEPATITIS OLDER AGE ALCOHOL
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HIVANTIVIRAL DRUGS
THE BENEFIT OF HAART THERAPY OUTWEIGHS THE RISK
OF TOXICITY MONITOR LIVER ENZYMES EARLY
RECOGNITION/HOLD CHECK DRUG-DRUG
INTERACTION ALCOHOL
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HIV-LIVER CONCLUSIONS
LIVER INVOLVEMENT IS COMMON INFECTIONS ARE MAIN
INVOLVEMENT IS SECONDARY/
OR PART OF DISSEMINATED DISEASE LIVER BIOPSY
CONFIRMS DIAGNOSIS BILIARY CHOLANGIOPATHY IS A
DISTINCT ENTITY DRUGS PLAY AN IMPORTANT
ITEOLOGICAL CAUSE WHICH NEEDS CLOSE FOLLOWUP
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