Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2017; 9(36): 1367-1371
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1367
Autoimmune hepatitis in the setting of human immunodeficiency virus infection: A case series
Madhavi Reddy, Mel A Ona, Daryl Ramai, Emmanuel Ofori
Emmanuel Ofori, Daryl Ramai, Madhavi Reddy, Division of Gastroenterology and Hepatology, the Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY 11201, United States
Daryl Ramai, Department of Anatomical Sciences, St. George’s University School of Medicine, Grenada, West Indies
Mel A Ona, Division of Advanced Endoscopy, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Author contributions: All authors contributed to the acquisition of data, writing and revision of this manuscript.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: The authors have no conflicts of interest or financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Daryl Ramai, Division of Gastroenterology and Hepatology, the Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, 121 Dekalb Avenue, Brooklyn, NY 11201, United States. dramai@sgu.edu
Telephone: +1-718-2508867
Received: July 28, 2017
Peer-review started: July 30, 2017
First decision: October 9, 2017
Revised: November 16, 2017
Accepted: December 6, 2017
Article in press: December 7, 2017
Published online: December 28, 2017
Processing time: 117 Days and 20.3 Hours
Abstract

Liver injury in the setting of human immunodeficiency virus (HIV) infection is more commonly attributed to viral hepatitis or highly active antiretroviral treatment (HAART) toxicity. The severity of liver injury is an important cause of morbidity and mortality. The emergence of autoimmune diseases, particularly autoimmune hepatitis (AIH) in the setting of HIV infection, is rare. Previous reports indicate that elevated liver enzymes are a common denominator amongst these patients. We present two patients with HIV infection, on HAART, with virological suppression. Both patients presented with elevated liver enzymes, and following liver biopsies, were diagnosed with AIH. The clinical course of these patients underscore the therapeutic value of corticosteroids, and in some cases, addition of immunosuppression for AIH treatment.

Keywords: Liver biopsy; Human immunodeficiency virus; Immunosuppression; Autoimmunity; Autoimmune hepatitis

Core tip: Liver damage is rarely caused by autoimmune disease in the setting of human immunodeficiency virus (HIV) infection. We describe a case series of two patients with a history of HIV, who presented with characteristic elevation in liver enzymes. Both patients were hepatitis C negative. Liver biopsies followed by histopathology confirmed the diagnosis of autoimmune hepatitis. Case 1 was treated by corticosteroids and azathioprine, while case 2 was treated by corticosteroids only. Both patients reported significant clinical improvement. These cases suggest that liver biopsy should be performed in HIV patients with unknown liver disease. Additionally, they underscore the need for further clinical studies to explore the role of corticosteroids and immunosuppression in the management of autoimmune hepatitis in HIV patients.