HIV-associated cholangitis

Etiology

• cytomegalovirus
• cryptosporidia
• microsporidia
• HIV1 itself

Pathology

• cholangitis of extrahepatic bile ducts
• ductal irregularity & narrowing

Clinical manifestations

• right upper quadrant or gastric pain (most patients)
  • frequently severe enough to require narcotics
  • generally described as sharp
  • may radiate to back
• nausea & vomiting (50%)
• fever (50%)
• cholestasis

Laboratory

• serum alkaline phosphatase 5X upper limit of reference interval
• serum transaminases 2-3X upper limit of reference interval
• serum bilirubin normal or slighly elevated

Radiology

• 4 distinct patterns
  • papillary stenosis
  • sclerosis cholangitis
  • long strictures of extrahepatic bile ducts
  • combined stenosis & cholangitis (most common)

Differential diagnosis

• pancreatitis

Management

• analgesia
  • opiates
• percutaneous biliary drainage

More general terms

• HIV1/AIDS-associated hepatobiliary disorder
• cholangitis

Additional terms

• human immunodeficiency virus (HIV)