Autoimmune hepatitis in human immunodeficiency virus infection: Case report and literature review

Abstract

The infection due to human immunodeficiency virus (HIV) is characterized by the progressive reduction of CD4⁺ T lymphocytes and the compromise of other cell lines of the immune system, resulting in immunosuppression. In this context, autoimmune diseases could be considered contradictory, however, cases of autoimmune diseases during this infection have been described, including autoimmune hepatitis (AIH), which is uncommon and has few case reports within medical literature, none of them from Latin America. In this case report where a patient with an HIV infection on combined antiretroviral treatment developed acute elevation of transaminases, hyperbilirubinemia, and deterioration in hepatic synthetic function. Although initially an antiretroviral drug-induced liver injury was suspected, during the study a diagnosis of autoimmune hepatitis was proven, which required treatment with corticosteroid and azathioprine, obtaining a satisfactory response and managing to continue the antiretroviral therapy. Autoimmune diseases in HIV infection must be taken into account. In the case of hepatitis in patients with HIV on antiretroviral treatment, the differentiation between viral hepatitis caused by autoimmune diseases or medications is essential to establish an adequate treatment, and avoid the suspension of the antiretroviral therapy.

Keywords: Autoimmunity; Autoimmune hepatitis; Human immunodeficiency virus; Anti-human immunodeficiency virus agents; Drug-induced liver injury

Core tip: In the combined antiretroviral therapy era, human immunodeficiency virus (HIV) infection can show diverse manifestations others than infections, been autoimmunity a paradoxical but well described phenomena in this scenario. The objective of this case report is to illustrate a rare condition as autoimmune hepatitis in HIV infected patients on therapy, with an additional literature review, to help clinicians in the approach of this disease and the differentiation with drug induced liver injury related to antiretroviral therapy.