Vanishing bile duct syndrome in human immunodeficiency virus infected adults: a report of two cases.

Vanishing bile duct syndrome (VBDS) is a group of rare disorders characterized by ductopenia, the progressive destruction and disappearance of intrahepatic bile ducts leading to cholestasis. Described in association with medications, autoimmune disorders, cancer, transplantation, and infections, the specific mechanisms of disease are not known. To date, only 4 cases of VBDS have been reported in human immunodeficiency virus (HIV) infected patients. We report 2 additional cases of HIV-associated VBDS and review the features common to the HIV-associated cases. Presentation includes hyperbilirubinemia, normal liver imaging, and negative viral and autoimmune hepatitis studies. In HIV-infected subjects, VBDS occurred at a range of CD4+ T-cell counts, in some cases following initiation or change in antiretroviral therapy. Lymphoma was associated with two cases; nevirapine, antibiotics, and viral co-infection were suggested as etiologies in the other cases. In HIV-positive patients with progressive cholestasis, early identification of VBDS and referral for transplantation may improve outcomes.

Outcome of HCV genotype 1 treatment in HIV-coinfected patients with chronic kidney disease.

Chronic renal insufficiency is a barrier for the treatment of hepatitis C virus (HCV), and yet virus clearance is desirable prior to kidney transplantation. Several reports document success of kidney transplantation in the setting of HIV infection. We analyzed the treatment outcome of patients with HIV and HCV genotype 1 infections and chronic kidney disease, who received pegylated interferon with or without ribavirin in our center. Of the 7 patients, 2 achieved sustained virological response. None of the responders had end-stage renal disease, suggesting that HCV treatment is most likely to be successful in earlier stages of renal disease.