The Spectrum of Liver Diseases in HIV Infected Individuals at an HIV Treatment Clinic in Kampala; Uganda

ABSTRACT

Background: Liver 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. Objective: To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala; Uganda. Method: Consecutive 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. Results: Seventy-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. Conclusion: Drug 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