Human Immunodeficiency Virus Book

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Hepatitis in HIV

Aka: Hepatitis in HIV, AIDS Cholangiopathy
  1. See Also
    1. Hepatitis
    2. Gastrointestinal Manifestations of HIV
    3. HIV Complications
  2. Epidemiology
    1. Hepatomegaly occurs in 50% of AIDS patients
  3. 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
  4. Labs
    1. Viral Hepatitis serologies
  5. Imaging
    1. Right Upper Quadrant Ultrasound
    2. CT Abdomen and Pelvis
    3. MRCP or ERCP (indicated for signs of biliary obstruction)
  6. Management
    1. Avoid Hepatotoxins (e.g. Alcohol)
    2. Manage comorbidities
      1. Alcohol Abuse
      2. Obesity
      3. Dyslipidemia
      4. Insulin Resistance
      5. Diabetes Mellitus
  7. Prevention
    1. Hepatitis A Vaccine
    2. Hepatitis B Vaccine
  8. References
    1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]

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