Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults

Lilishia Gounder,Andrew J Hickey,Mahomed-Yunus S Moosa,Pravikrishnen Moodley,Paul K Drain

doi:10.1186/s12879-017-2222-2

Abstract

BackgroundAlthough Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults.MethodsRetrospective study of patients diagnosed with hepatic TB from 2005–2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa.ResultsAmong twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/μl (inter-quartile range 27–107 cells/μl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322–1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235–736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died.ConclusionIn our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.

Highlights

Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in Human Immunodeficiency Virus (HIV)-infected adults, HIV-associated hepatic TB has been poorly characterized
We included all patients diagnosed with hepatic TB from 2005 to 2012 at the Infectious Diseases Clinic (IDC), a referral-based specialist service focused on the management of complex infectious diseases including HIV and TB
We identified twenty patients with HIV-associated hepatic TB (Table 1)

Summary

Introduction

Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults. Mycobacterium tuberculosis (TB) and Human Immunodeficiency Virus (HIV) cause a high rate of morbidity and mortality worldwide [1]. 1.2 million HIV-infected people developed active TB infection worldwide in 2014, of which 74% were in sub-Saharan Africa [2]. TB most commonly causes a pulmonary infection, patients with advanced immunosuppression. Hepatic TB can occur as a localized primary infection or by dissemination of a pulmonary infection, known as miliary hepatic TB [5]. Local hepatic TB occurs when ingested TB bacilli cross the gastrointestinal mucosal barrier to reach the liver via the portal vein [6]. Disseminated disease via the hepatic artery is more common, and results in multiple small tubercles in the liver [6]

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