HIV and Autoimmune Hepatitis: A Case Series and Literature Review

Abstract

Liver disease is the leading cause of non-AIDS related morbidity and mortality in human immunodeficiency virus (HIV) infected patients. There are many causes of liver disease in these patients, most commonly co-infection with viral hepatitis or alcoholic liver disease. A far less commonly described entity is autoimmune hepatitis (AIH) in HIV patients. The relationship between HIV and autoimmune diseases is well-described in a few conditions such as systemic lupus erythematosus and diffuse infiltrative lymphocytosis syndrome; however, patients with HIV who subsequently develop autoimmune hepatitis (AIH) has rarely been described in the existing literature. Managing these coexisting morbidities requires careful monitoring, as treating AIH requires the further immunosuppression of an HIV-infected individual. Herein, we present two patients who were diagnosed with and treated for AIH while receiving concurrent highly active anti-retroviral therapy. This case series provides treatment outcome data for a situation that has heretofore been rarely reported.Figure: A. Liver biopsy from case patient #1. On left, fibrous septum containing a dense lymphoplasmacytic inflammatory infiltrate with prominent interface and lobular activity. 100x; hematoxylin and eosin. On right, dense plasma cell-rich infiltrate and an area of hepatocyte drop-out at the interface. 400x; hematoxylin and eosin. Biopsy is compatible with autoimmune hepatitis. B. Liver biopsy from case patient #2. On left, dense portal lymphoplasmacytic inflammation with prominent interface and lobular activity. 100x; hematoxylin and eosin. On right, lobular lymphoplasmacytic inflammation with hepatocyte rosette formation. 400x; hematoxylin and eosin. Biopsy is typical for autoimmune hepatitis.Figure: A timeline that plots patient liver function tests in relationship to initiation of autoimmune hepatitis (AIH) targeted therapy. Both patients were started on prednisone. Patient CD4 counts (cells/mL) are also shown.Table: Table. A review of the existing literature on patients with HIV who developed AIH. CD4 count is in cells/microliter and viral load is in copies/microliter