II. Epidemiology

  1. Hepatomegaly occurs in 50% of AIDS patients

III. Differential Diagnosis

  1. Diffuse hepatocellular disease
  2. Granulomatous hepatitis
  3. Sclerosing Cholangitis syndrome
    1. Cytomegalovirus
    2. Cryptosporidium
  4. Viral Hepatitis (accelerated course to liver failure)
    1. Hepatitis B
    2. Hepatitis C
      1. Strongly consider Hepatitis C Antiviral Regimen (90% sustained response)
      2. http://www.hcvguidelines.org/unique-populations/hiv-hcv
  5. Cholestatic hepatitis (consider occult infection)
    1. Mycobacterium Avium Complex (MAC)
    2. Mycobacterium tuberculosis
    3. Histoplasmosis,
    4. Coccidioidomycosis
    5. Cryptococcus
    6. Kaposi's Sarcoma
    7. Non-Hodgkin's Lymphoma
    8. HIV-associated Peliosis Hepatitis
    9. Drug induced cholestasis
    10. Steatosis (macrovesicular and microvesicular)
      1. Nonalcoholic Fatty Liver
      2. Alcoholic Fatty Liver

IV. Labs

  1. Viral Hepatitis serologies

V. Imaging

  1. Right Upper Quadrant Ultrasound
  2. CT Abdomen and Pelvis
  3. MRCP or ERCP (indicated for signs of biliary obstruction)

VI. Management

  1. Avoid Hepatotoxins (e.g. Alcohol)
  2. Manage comorbidities
    1. Alcohol Abuse
    2. Obesity
    3. Dyslipidemia
    4. Insulin Resistance
    5. Diabetes Mellitus

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