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.
KeywordsCholangitis Sclerosing Cholangitis Ursodeoxycholic Acid Endoscopic Sphincterotomy Cryptosporidiosis
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References and Recommended Reading
- 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
- 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
- 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
- 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