HIV as A Cause of Acute Liver Injury

Abstract

While hepatitis is the most common infectious cause of acute liver injury, although rare, acute human immunodeficiency virus (HIV) infection should be considered in the workup for infectious causes of acute liver injury. We present a case of a 36 year old woman with no past medical history who presented to the hospital for 8 days of abdominal pain and nausea worsened with food. Labs were significant for lymphocytopenia, transaminitis, elevated alkaline phosphatase, and direct bilirubinemia. Viral hepatitis serologies were negative and imaging showed nonspecific gallbladder wall thickening, no gallbladder stones, no intra or extra-hepatic biliary ductal dilatation. No evidence of congestive heart failure. Serologies for cytomegalovirus (CMV), Epstein Barr virus (EBV), rickettsia, enterovirus, adenovirus, and parvovirus were negative. Workup for autoimmune liver disease was also negative. Liver biopsy was notable for a focus of granulomatous necrosis, suggestive of infectious or drug induced etiology. During this admission, patient was also found to have a new diagnosis of HIV with CD4 count of 235. Patient was started on bictegravir, emtricitabine, and tenofovir alafenamide with progressive improvement and eventual resolution of AST, ALT, alkaline phosphatase, and bilirubin elevation since starting anti-retroviral therapy.*++