AIDS cholangiopathy

AIDS cholangiopathy

A bile obstruction syndrome caused by infection-related strictures of the biliary tract, which occurred in up to 25% of patients in the pre-HAART (highly active antiretroviral therapy) era; it is more common in those with CD4 counts of < 100/mm3.

Clinical findings
Chronic right upper quadrant and epigastric pain, low-grade fever, diarrhoea, cholestasis with bile duct ectasia, bile duct defects, papillary stenosis.
 
Aetiology
Cryptosporidium parvum, CMV, Microsporidium, Enterocytozoon bieneusi, Encephalitozoon intestinalis, Mycobacteriium tuberculosis.
References in periodicals archive ?
AIDS cholangiopathy is suspected when patients with advanced human immunodeficiency virus (HIV) infection present with right upper quadrant abdominal pain, diarrhoea, jaundice, and fever [3].
All these features were suggestive of AIDS cholangiopathy (Figure 1(a)).
We describe here a patient with AIDS cholangiopathy due to CMV occurring within 2 months of switching to effective HAART.
Three reports of CMV-induced duodenal papillitis in AIDS patients and 32 cases of CMV-induced AIDS cholangiopathy have been described till date.
AIDS cholangiopathy secondary to IRIS has been reported only once, presented as paradoxical IRIS secondary to Crytposporidium [7].
The therapy of AIDS cholangiopathy is primarily endoscopic, and the approach varies with the anatomic abnormality.
There is a possibility that our patient may have had a CMV OI presenting as AIDS cholangiopathy. However, our patient had CD4 count of 109/[micro]L, and most cases of CMV AIDS cholangiopathy have been described in severely immunocompromised hosts with CD4 <100/[micro]L.
In conclusion, we report the first case of AIDS cholangiopathy due to CMV presenting as unmasking IRIS.
One female had features suggestive of AIDS cholangiopathy at ERCP and EUS (Endoscopic Ultrasound).
AIDS cholangiopathy. Curr Treat Options Gastroenterol 2004;7:111-117.

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