subject: Complications in AIDS [print this page] Complications in AIDS Complications in AIDS
Hepatitis and cholestasis At all stages of HIV infection the commonest causes ofacute hepatitis, both symptomatic and asymptomatic, areeither drug toxicity or coinfection with viral hepatitis Bor C. Treatment with many of the current antiretroviralagents is associated with a risk of drug-induced hepatitis,e.g. the nucleoside analogue stavudine, the non-nucleosidereverse transcriptase inhibitor nevirapine (usually in associationwith a rash and fever) and the protease inhibitorritonavir. Severe acute hepatitis with liver failure secondaryto hepatitic steatosis (in which the liver cells arefilled with small fat droplets) is a rare complication oftreatment with the reverse transcriptase inhibitors. Drugsused to treat specific acute opportunistic infections mayalso be implicated, and include the antimycobacterialagents, systemic azoles and high-dose co-trimoxazole.When multiple drugs are being taken then drug-inducedhepatitis must always be considered.Acute primary infection with viral hepatitis A, B or Cshould be considered. Chronic infection with viral hepatitisB and C is more common among homosexual men andinjecting drug users. In those coinfected with HIV there isa higher likelihood of progression to more severe chronicliver disease and cirrhosis.In patients with AIDS specific opportunistic infectionscan cause hepatitis, which may present as fever, abdominalpain and hepatomegaly. If an ultrasound does not showdilated intra- or extrahepatitic bile ducts, suggestingobstruction, needle biopsy often shows granuloma hepatitis,usually caused by atypical mycobacteria rather than M.tuberculosis. The herpes viruses may also occasionallycause hepatitis as part of a disseminated infection.Acalculous cholecystitis and cholangitis show an endoscopicretrograde cholangiographic picture similar to thatof primary sclerosing cholangitis, with strictures anddilatation of the biliary tree. Cryptosporidium and cytomegalovirushave been isolated and are implicated as acause of this syndrome
