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Digestive Diseases and Sciences

, Volume 38, Issue 6, pp 1113–1118 | Cite as

AIDS-related cholangiopathy

Critical analysis of a prospective series of 26 patients
  • Yves Benhamou
  • Eric Caumes
  • Yves Gerosa
  • Jean François Cadranel
  • Elisabeth Dohin
  • Christine Katlama
  • Paul Amouyal
  • Jean Marc Canard
  • Nabih Azar
  • Catherine Hoang
  • Yves Le Charpentier
  • Marc Gentilini
  • Pierre Opolon
  • Dominique Valla
Original Articles

Abstract

Several types of biliary tract abnormality of undertermined origin have been described among AIDS patients. The aims of this study are (1) to evaluate whether biliary tree involvement is in fact one or several homogeneous morphological entities, (2) to specify the role of CMV orCryptosporidium sp. infection, and (3) to evaluate the possible efficacy of treatment. Since ultrasound had revealed abnormality in the biliary tree, 26 consecutive AIDS patients underwent cholangiography. Cholangiograms enabled us to distinguish between two types of biliary tract involvement: (1) gradual and regular stenosis of the terminal portion of the common bile duct associated with dilation but without irregularity of the intrahepatic biliary ducts was present in 27% of our cases, and (2) distal stenosis of the extrahepatic biliary ducts combined with diffuse irregularity of the caliber of the intrahepatic bile ducts was present in 73% of our cases. Concomitant infection by CMV orCryptosporidium sp. was significantly more frequent when intrahepatic duct irregularities were present (94%) than when absent (14%,P<0.001). Anti-CMV treatment and sphincterotomy were unsuccessful in treating anomalies of the intrahepatic biliary tract. Conversely, sphincterotomy caused rapid and lasting disappearance of pain in all our patients. In conclusion, biliary tract involvement in AIDS patients is of two types. CMV infection and infection byCryptosporidium sp. are most frequent when the large intrahepatic ducts are implicated.

Key Words

AIDS biliary tract cholangiopathy 

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References

  1. 1.
    Cello JP: Acquired immunodeficiency syndrome cholangiopathy: Spe trum of disease. Am J Med 86:539–546, 1989Google Scholar
  2. 2.
    Dolmath B, Laing FC, Federle MP, Jeffrey RB, Cello JP: AIDS-related cholangitis: Radiographic finding in nine patients. Radiology 163:313–316, 1987Google Scholar
  3. 3.
    MacCarty M, Choudhri AH, Helbert M, Crofton ME: Radiological features of AIDS related cholangitis. Clin Radiol 40:582–585, 1989Google Scholar
  4. 4.
    Dowsett JF, Miller R, Davidson R, Vaira D, Polydorou A, Cairns SR, Weller IVD: Sclerosing cholangitis in acquired immunodeficiency syndrome. Scand J Gastroenterol 23:1267–1274, 1988Google Scholar
  5. 5.
    Margulis SJ, Honig CL, Soave R, Govoni AF, Mouradian JA, Jacobson IM: Biliary tract obstruction in the acquired immunodeficiency syndrome. Ann Intern Med 105:207–210, 1986Google Scholar
  6. 6.
    Schneiderman DJ, Arenson DM, Cello JP, Margaretten W, Weber T: Hepatic disease in patients with the acquired immune deficiency syndrome (AIDS). Hepatology 7:925–930, 1987Google Scholar
  7. 7.
    Viteri AL, Greene JF: Bile duct abnormalities in the acquired immune deficiency syndrome. Gastroenterology 92:2014–2018, 1987Google Scholar
  8. 8.
    Agha FP, Nostrant TT, Abrams GD, Mazanec M, Van Moll L, Gumucio JJ: Cytomegalovirus cholangitis in a homosexual man with acquired immune deficiency syndrome. Am J Gastroenterol 81:1068–1072, 1986Google Scholar
  9. 9.
    Texidor HS, Honig CL, Norsoph E, Albert S, Mouradian JA, Whalen JP: Cytomegalovirus infection of the alimentary canal: Radiologic findings with pathologic correlation. Radiology 163:317–323, 1987Google Scholar
  10. 10.
    Schneiderman DJ, Cello JP, Laing FC: Papillary stenosis and sclerosing cholangitis in the acquired immuno deficiency syndrome. Ann Intern Med 1064:546–549, 1987Google Scholar
  11. 11.
    Blumberg RS, Kelsey P, Perrone T, Dickersin R, Laquaglia M, Ferruchi J: Cytomegalovirus- andCryptosporidium-associated acalculous cholecystitis. Am J Med 76:1118–1123, 1984Google Scholar
  12. 12.
    Ten Napel HH, Houthoff HJ, The TH: Cytomegalovirus hepatitis in normal and immune compromised host. Liver 4:184–194, 1984Google Scholar
  13. 13.
    Jacobson MA, Cello JP, Sande MA: Cholestasis and disseminated cytomegalovirus disease in patients with the acquired immunodeficiency syndrome. Am J Med 84:218–224, 1988Google Scholar
  14. 14.
    Kavin H, Jonas RB, Chowdhury L, Kabins S: Acalculous cholecystitis and cytomegalovirus infection in the acquired immunodeficiency syndrome. Ann Intern Med 104:53–54, 1986Google Scholar
  15. 15.
    Palmer M, Braly LF, Schaffner F: The liver in acquired immuno deficiency disease. Semin Liver Dis 7(3):192–202, 1987Google Scholar
  16. 16.
    Roulot D, Valla D, Brun Vezinet F, Rey MA, Clavel F, Degott C, Guillan J, Verduron J, Rueff B, Benhamou JP: Cholangitis in the acquired immunodeficiency syndrome: Report of two cases and review of the literature. Gut 28:1653–1660, 1987Google Scholar
  17. 17.
    Marche C, Zoubi D, Michon C: Les lésions hépatiques, biliaires et pancréatiques au cours de l'infection par LAV-HTLV III. Ann Pathol 6(4–5):287–291, 1986Google Scholar
  18. 18.
    Kahn DG, Garfinkle JM, Klonoff DC, Pembrook LJ, Morrow DJ: Cryptosporidial and cytomegaloviral hepatitis and cholecystitis. Arch Pathol Lab Med 111:879–881, 1987Google Scholar
  19. 19.
    Centers for Disease Control: Classification system for human T lymphotroic virus type III/lymphadenopathy associated virus infection. Ann Intern Med 105:234–237, 1986Google Scholar
  20. 20.
    Welch K, Finkbeiner W, Alpers CE, Blumenfeld M, Davis RL, Smuckler EA, Beckstead JH: Autopsy findings in the acquired immune deficiency syndrome. JAMA 252(9):1152–1159, 1984Google Scholar
  21. 21.
    Erice A, Chou S, Biron KK, Stanat S, Balfour HH, Jordan C: Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients. N Engl J Med 320:289–293, 1989Google Scholar
  22. 22.
    Rene E, Marche C, Chevalier T, Rouzioux C, Regnier B, Saimot AG, Negesse Y, Matheron S, Leport C, Wolff B, Moriniere B, Katlama C, Godeberge B, Vittecoq B, Bricaire F, Brun Vesinet C, Pangon B, Deluol AM, Coulaud JP, Modai J, Frottier J, Vilde JL, Vachon M, Mignon M, Bonfils S: Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome. Dig Dis Sci 33:741–750, 1988Google Scholar
  23. 23.
    Foucar E, Mukai K, Foukar K, Sutherland DE, Van Buren TC: Colon ulcerations in lethal cytomegalovirus infection. Am J Pathol 76:788–801, 1981Google Scholar
  24. 24.
    Eidelberg D, Sotrel A, Vogel M, Walter P, Kleefrelfd J, Grumpacker CS: Progressive polyradiculopathy in acquired immune deficiency syndrome. Neurology 36:912–916, 1986Google Scholar
  25. 25.
    Morgello S, Cho ES, Nielsen S, Devinsky O, Petito CK: Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome. An autopsy study of 30 cases and a review of the literature. Hum Pathol 18:289–297, 1987Google Scholar
  26. 26.
    Koeppen AH, Lansig LS, Peng SK, Smith RS: Central nervous system vasculitis in cytomegalovirus infection. J Neurol Sci 51:395–410, 1981Google Scholar
  27. 27.
    Burt AD, Scott G, Shiack CR, Isles CG: Acquired immunodeficiency syndrome in a patient with no known risk factors: A pathological study. J Clin Pathol 37:471–474, 1984Google Scholar
  28. 28.
    Bardin T, Gandoven C, Kuntz A: Necrotizing vasculitis in human immunodeficiency virus infection. Arthritis Rheum 30:S1055, 1987 (abstract)Google Scholar
  29. 29.
    Gherardi R, Lebargy F, Gaulard G, Mhini C, Bernandin JF, Gray F: Necrotizing vasculitis and HIV replication in peripheral veins. N Engl J Med 321:685–686, 1989Google Scholar
  30. 30.
    Greenson JK, Belistos PC, Yardley JH, Bartlett JG: AIDS enteropathy: Occult enteric infections and duodenal mucosal alteration in chronic diarrhea. Ann Intern Med 114:366–372, 1991Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Yves Benhamou
    • 1
    • 2
    • 3
  • Eric Caumes
    • 1
    • 2
    • 3
  • Yves Gerosa
    • 1
    • 2
    • 3
  • Jean François Cadranel
    • 1
    • 2
    • 3
  • Elisabeth Dohin
    • 1
    • 2
    • 3
  • Christine Katlama
    • 1
    • 2
    • 3
  • Paul Amouyal
    • 1
    • 2
    • 3
  • Jean Marc Canard
    • 1
    • 2
    • 3
  • Nabih Azar
    • 1
    • 2
    • 3
  • Catherine Hoang
    • 1
    • 2
    • 3
  • Yves Le Charpentier
    • 1
    • 2
    • 3
  • Marc Gentilini
    • 1
    • 2
    • 3
  • Pierre Opolon
    • 1
    • 2
    • 3
  • Dominique Valla
    • 1
    • 2
    • 3
  1. 1.Service d'Hépato-GastroenterologieGroupe Hospitalier Pitié-SalpétrièreParis Cédex 13France
  2. 2.Service des Maladies Tropicales et ParasitairesGroupe Hospitalier Pitié-SalpétrièreParis Cédex 13France
  3. 3.Laboratoire Central d'AnatomopathologieGroupe Hospitalier Pitié-SalpétrièreParis Cédex 13France

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