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AIDS cholangiopathy

  • Tony E. Yusuf
  • Todd H. Baron
Article

Opinion statement

AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated. Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy. Four distinct cholangiographic abnormalities have been demonstrated by endoscopic retrograde cholangiopancreatography, the most common being papillary stenosis with sclerosing cholangitis. Antimicrobial therapy is often ineffective. Highly active antiretroviral therapy may enhance immune function and offers the best medical therapy to clear the opportunistic infections. Ursodeoxycholic acid has a limited benefit in patients with sclerosing cholangitis and cholestasis. Endoscopic sphincterotomy has been shown to relieve pain and biliary obstruction in patients with papillary stenosis. Balloon dilation of strictures and stent placement decompress the biliary system and may be helpful. Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain.

Keywords

Cholangitis Sclerosing Cholangitis Ursodeoxycholic Acid Endoscopic Sphincterotomy Cryptosporidiosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Bonacini M: Hepatobiliary complications in patients with human immunodeficiency virus infection. Am J Med 1992, 92:404–411.PubMedCrossRefGoogle Scholar
  2. 2.
    Schneiderman DJ: Hepatobiliary abnormalities of AIDS. Gastroenterol Clin North Am 1988, 17:615–630.PubMedGoogle Scholar
  3. 3.
    Cello JP: Acquired immunodeficiency syndrome cholangiopathy: spectrum of disease. Am J Med 1989, 86:539–546.PubMedCrossRefGoogle Scholar
  4. 4.
    Guarda LA, Stein SA, Cleary KA, Ordonez NG: Human cryptosporidiosis in the acquired immune deficiency syndrome. Arch Pathol Lab Med 1983, 107:562–566.PubMedGoogle Scholar
  5. 5.
    Pitlik SD, Fainstein V, Garza D, et al.: Human cryptosporidiosis: spectrum of disease. Report of six cases and review of the literature. Arch Intern Med 1983, 143:2269–2275.PubMedCrossRefGoogle Scholar
  6. 6.
    Blumberg RS, Kelsey P, Perrone T, et al.: Cytomegalovirus- and Cryptosporidium-associated acalculous gangrenous cholecystitis. Am J Med 1984, 76:1118–1123.PubMedCrossRefGoogle Scholar
  7. 7.
    Margulis SJ, Honig CL, Soave R, et al.: Biliary tract obstruction in the acquired immunodeficiency syndrome. Ann Intern Med 1986, 105:207–210.PubMedGoogle Scholar
  8. 8.
    Schneiderman DJ, Cello JP, Laing FC: Papillary stenosis and sclerosing cholangitis in the acquired immunodeficiency syndrome. Ann Intern Med 1987, 106:546–549.PubMedGoogle Scholar
  9. 9.
    Viteri AL, Greene JF Jr: Bile duct abnormalities in the acquired immune deficiency syndrome. Gastroenterology 1987, 92:2014–2018.PubMedGoogle Scholar
  10. 10.
    Cello JP, Chan MF: Long-term follow-up of endoscopic retrograde cholangiopancreatography sphincterotomy for patients with acquired immune deficiency syndrome papillary stenosis. Am J Med 1995, 99:600–603.PubMedCrossRefGoogle Scholar
  11. 11.
    Vakil NB, Schwartz SM, Buggy BP, et al.: Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N Engl J Med 1996, 334:19–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Bouche H, Housset C, Dumont JL, et al.: AIDS-related cholangitis: diagnostic features and course in 15 patients. J Hepatol 1993, 17:34–39.PubMedCrossRefGoogle Scholar
  13. 13.
    Benhamou Y, Caumes E, Gerosa Y, et al.: AIDS-related cholangiopathy. Critical analysis of a prospective series of 26 patients. Dig Dis Sci 1993, 38:1113–1118.PubMedCrossRefGoogle Scholar
  14. 14.
    Dolmatch BL, Laing FC, Ferderle MP, et al.: AIDS-related cholangitis: radiographic findings in nine patients. Radiology 1987, 163:313–316.PubMedGoogle Scholar
  15. 15.
    Lyche KD, Savides TJ, Weiner KJ, Goldklang RH: AIDS cholangiopathy: the role of therapeutic ERCP [abstract]. Gastrointest Endosc 1994, 40:P117.CrossRefGoogle Scholar
  16. 16.
    Pol S, Romana CA, Richard S, et al.: Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993, 328:95–99.PubMedCrossRefGoogle Scholar
  17. 17.
    Sheikh RA, Prindiville TP, Yenamandra S, et al.: Microsporidial AIDS cholangiopathy due to Encephalitozoon intestinalis: case report and review. Am J Gastroenterol 2000, 95:2364–2371.PubMedCrossRefGoogle Scholar
  18. 18.
    Aronson NE, Cheney C, Rholl V, et al.: Biliary giardiasis in a patient with human immunodeficiency virus. J Clin Gastroenterol 2001, 33:167–170.PubMedCrossRefGoogle Scholar
  19. 19.
    Farman J, Brunetti J, Baer JW, et al.: AIDS-related cholangiopancreatographic changes. Abdom Imaging 1994, 19:417–422.PubMedCrossRefGoogle Scholar
  20. 20.
    Sifuentes-Osornio J, Porras-Cortes G, Bendall RP, et al.: Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation. Clin Infect Dis 1995, 21:1092–1097.PubMedGoogle Scholar
  21. 21.
    Forbes A, Blanshard C, Gazzard B: Natural history of AIDS related sclerosing cholangitis: a study of 20 cases. Gut 1993, 34:116–121.PubMedGoogle Scholar
  22. 22.
    Chalasani N, Wilcox M: Etiology, evaluation, and outcome of jaundice in patients with acquired immunodeficiency syndrome. Hepatology 1996, 23:728–733.PubMedCrossRefGoogle Scholar
  23. 23.
    Iannuzzi C, Belghiti J, Erlinger S, et al.: Cholangitis associated with cholecystitis in patient with acquired immunodeficiency syndrome. Arch Surg 1990, 125:1211–1213.PubMedGoogle Scholar
  24. 24.
    Levenson SD, Koch J, Schlueck G, Cello JP: Sphincter of oddi dysfunction (SOD) in patients with suspected AIDS cholangiopathy [abstract]. Gastrointest Endosc 1994, 40:P116.CrossRefGoogle Scholar
  25. 25.
    Hocqueloux L, Gervais A: Cholangiocarcinoma and AIDS-related sclerosing cholangitis. Ann Intern Med 2000, 132:1006–1007.PubMedGoogle Scholar
  26. 26.
    Da Silva F, Boudghene F, Lecomte I, et al.: Sonography in AIDS-related cholangitis: prevalence and cause of an echogenic nodule in the distal end of the common bile duct. Am J Roentgenol 1993, 160:1205–1207.Google Scholar
  27. 27.
    Daly CA, Padley SP: Sonographic prediction of a normal or abnormal ERCP in suspected AIDS related sclerosing cholangitis. Clin Radiol 1996, 51:618–621.PubMedCrossRefGoogle Scholar
  28. 28.
    Brunetti JC, Van Heertum RL, Kempf JS, et al.: Tc-99m DISIDA hepatobiliary scintigraphy in AIDS cholangitis. Clin Nucl Med 1994, 19:36–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Moore RD, Chaisson RE: Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS 1999, 13:1933–1942.PubMedCrossRefGoogle Scholar
  30. 30.
    Ko WF, Cello JP, Rogers SJ, et al.: Prognostic factors for the survival of patients with AIDS cholangiopathy. Am J Gastroenterol 2003, 98:2176–2181. This study highlights the impact of HAART and other prognostic factors on the survival of patients with AIDS cholangiopathy.PubMedCrossRefGoogle Scholar
  31. 31.
    Kadappu KK, Nagaraja MV, Rao PV, Shastry BA: Azithromycin as treatment for cryptosporidiosis in human immunodeficiency virus disease. J Postgrad Med 2002, 48:179–181.PubMedGoogle Scholar
  32. 32.
    White AC, Chappell CL, Hayat CS, et al.: Paromomycin for cryptosporidiosis in AIDS: a prospective, doubleblind trial. J Infect Dis 1994, 170:419–424.PubMedGoogle Scholar
  33. 33.
    Hamour AA, Bonnington A, Hawthorne B, Wilkins EG: Successful treatment of AIDS-related cryptosporidial sclerosing cholangitis. AIDS 1993, 7:1449–1451.PubMedCrossRefGoogle Scholar
  34. 34.
    Sifuentes-Osornio J, Porras-Cortes G, Bendall RP, et al.: Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation. Clin Infect Dis 1995, 21:1092–1097.PubMedGoogle Scholar
  35. 35.
    Casseb J, Fonseca LA, Veiga AP, et al.: AIDS incidence and mortality in a hospital-based cohort of HIV-1-seropositive patients receiving highly active antiretroviral therapy in Sao Paulo, Brazil. AIDS Patient Care STDS 2003, 17:447–452.PubMedCrossRefGoogle Scholar
  36. 36.
    Palella FJ Jr, Delaney KM, Moorman AC, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998, 338:853–860.PubMedCrossRefGoogle Scholar
  37. 37.
    Maggi P, Larocca AM, Quarto M, et al.: Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 2000, 19:213–217.PubMedCrossRefGoogle Scholar
  38. 38.
    Miao YM, Awad-El-Kariem FM, Franzen C, et al.: Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy. J AIDS 2000, 25:124–129.Google Scholar
  39. 39.
    Carr A, Marriott D, Field A, et al.: Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 1998, 351:256–261.PubMedCrossRefGoogle Scholar
  40. 40.
    Pares A, Caballeria L, Rodes J, et al.: Long-term effects of ursodeoxycholic acid in primary biliary cirrhosis: results of a double-blind controlled multicentric trial. UDCACooperative Group from the Spanish Association for the Study of the Liver. J Hepatol 2000, 32:561–566.PubMedCrossRefGoogle Scholar
  41. 41.
    Okolicsanyi L, Groppo M, Floreani A, et al.: Treatment of primary sclerosing cholangitis with low-dose ursodeoxycholic acid: results of a retrospective Italian multicentre survey. Dig Liver Dis 2003, 35:325–331.PubMedCrossRefGoogle Scholar
  42. 42.
    Castiella A, Iribarren JA, Lopez P, et al.: Ursodeoxycholic acid in the treatment of AIDS-associated cholangiopathy. Am J Med 1997, 103:170–171.PubMedGoogle Scholar
  43. 43.
    Cordero E, Lopez-Cortes LF, Belda O, et al.: Acquired immunodeficiency syndrome-related cryptosporidial cholangitis: resolution with endobiliary prosthesis insertion. Gastrointest Endosc 2001, 53:534–535.PubMedCrossRefGoogle Scholar
  44. 44.
    Adolph MD, Bass SN, Lee SK, et al.: Cytomegaloviral acalculous cholecystitis in acquired immunodeficiency syndrome patients. Am Surg 1993, 59:679–684.PubMedGoogle Scholar
  45. 45.
    Leiva JI, Etter EL, Gathe J Jr, et al.: Surgical therapy for 101 patients with acquired immunodeficiency syndrome and symptomatic cholecystitis. Am J Surg 1997, 174:414–416.PubMedCrossRefGoogle Scholar
  46. 46.
    Gress F, Schmitt C, Sherman S, et al.: Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 2001, 96:409–416.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee JM: CT-guided celiac plexus block for intractable abdominal pain. J Korean Med Sci 2000, 15:173–178.PubMedGoogle Scholar
  48. 48.
    Hol PK, Kvarstein G, Viken O, et al.: MRI-guided celiac plexus block. J Magn Reson Imaging 2000, 12:562–564.PubMedCrossRefGoogle Scholar
  49. 49.
    Collazos J, Mayo J, Martinez E, et al.: Celiac plexus block as treatment for refractory pain related to sclerosing cholangitis in AIDS patients. J Clin Gastroenterol 1996, 23:47–49.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Tony E. Yusuf
    • 1
  • Todd H. Baron
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterUSA

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