Noreña I, Morantes-Caballero JA, Garcés A, Gómez BJ, Rodríguez G, Saavedra C, Otero W. Autoimmune hepatitis in human immunodeficiency virus infection: Case report and literature review. World J Clin Infect Dis 2017; 7(4): 50-57 [DOI: 10.5495/wjcid.v7.i4.50]
Corresponding Author of This Article
Jairo A Morantes-Caballero, Professor of Internal Medicine I, Department of Internal Medicine, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Carrera 30 No. 45-03. Facultad de Medicina, Edificio 471, Oficina 510, Bogotá 111321, Colombia. jamorantesc@unal.edu.co
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Clin Infect Dis. Nov 25, 2017; 7(4): 50-57 Published online Nov 25, 2017. doi: 10.5495/wjcid.v7.i4.50
Autoimmune hepatitis in human immunodeficiency virus infection: Case report and literature review
Ivan Noreña, Jairo A Morantes-Caballero, Andrés Garcés, Brian José Gómez, Gabriel Rodríguez, Carlos Saavedra, William Otero
Ivan Noreña, Gabriel Rodríguez, Carlos Saavedra, Infectious Diseases Section, Department of Internal Medicine, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Bogotá 11321, Colombia
Jairo A Morantes-Caballero, Andrés Garcés, Brian José Gómez, Department of Internal Medicine, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Bogotá 11321, Colombia
William Otero, Gastroenterology Section, Department of Internal Medicine, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Bogotá 11321, Colombia
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Universidad Nacional de Colombia.
Informed consent statement: The patient gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
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: Jairo A Morantes-Caballero, Professor of Internal Medicine I, Department of Internal Medicine, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Carrera 30 No. 45-03. Facultad de Medicina, Edificio 471, Oficina 510, Bogotá 111321, Colombia. jamorantesc@unal.edu.co
Telephone: +57-1-3165000 Fax: +57-1-3165000
Received: June 12, 2017 Peer-review started: June 15, 2017 First decision: July 20, 2017 Revised: August 2, 2017 Accepted: September 12, 2017 Article in press: September 13, 2017 Published online: November 25, 2017 Processing time: 161 Days and 1.7 Hours
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.
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.
