The spectrum of liver diseases in HIV infected individuals at an HIV treatment clinic in Kampala, Uganda |
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| Authors: | Ponsiano Ocama Michael Katwere Theresa Piloya Jordan Feld Kenneth C Opio Andrew Kambugu Elly Katabira David Thomas Robert Colebunders and Allan Ronald |
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| Affiliation: | 1.Infectious Diseases Institute;2.National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK);3.Departement of Medicine, Makerere University;4.Johns Hopkins University;5.Institute of Tropical Medicine and University of Antwerp |
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| Abstract: | BackgroundLiver diseases are common in patients with HIV due to viral hepatitis B and C co-infections, opportunistic infections or malignancies, antiretroviral drugs and drugs for opportunistic infections.ObjectiveTo describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala, Uganda.MethodConsecutive patients presenting with jaundice, right upper quadrant pain with fever or malaise, ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease.ResultsSeventy-seven consecutive patients were recruited over an eleven month period. Of these, 23 (30%) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61%) patients with drug-induced liver disease presented with jaundice, all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15%) patients while anti-hepatitis C antibody was reactive in only 2 (3%). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9%) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease, AIDS cholangiopathy, hepatocellular carcinoma, schistosomiasis, haemangioma and hepatic adenoma. Twelve (16%) patients died during follow-up of which 7 (9%) died because of liver disease.ConclusionDrug history, liver enzyme studies, ultrasound, and hepatitis B and C investigations identified the probable etiology in 60 (78%) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease. |
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