Autoimmune Hepatitis in People Living with HIV: A Case Series and Review of Literature

• Published in: The open AIDS journal Vol. 17; pp. 1 - 7
• Main Authors: Laurenda, Obeng, Anneka, Patel, Giovanni, Villa, Adele, Mourad, Max, Whibley, Yvonne, Gilleece, Sumita, Verma
• Format: Journal Article
• Language: English
• Published: Sharjah Benham Science Publishers 01.01.2023
• Subjects: Alcohol; Biopsy; Drug dosages; Drug use; Enzymes; Hepatitis; HIV; Human immunodeficiency virus; Immune system; Liver cirrhosis; Liver diseases; Medical diagnosis; Remission (Medicine); Ultrasonic imaging
• ISSN: 1874-6136; 1874-6136
• DOI: 10.2174/18746136-v17-230825-2023-15,2023,17,el87461362307310

Additionally, diagnosis is challenging as there can be multiple reasons for abnormal liver tests in people living with HIV. Since autoimmune hepatitis responds well to immunosuppression and delaying treatment can be detrimental, its diagnosis and treatment must not be delayed or missed. Conclusion: Autoimmune hepatitis, though rare, must be considered in the differential diagnosis of abnormal liver tests in people living with human immunodeficiency virus. Hyperactivation of B cells has been implicated in causing an altered autoimmune profile, the most common serum abnormality being polyclonal hypergammaglobulinemia [2], Reported autoimmune conditions in PLWH include systemic lupus erythematosus, anti-phospholipid syndrome, vasculitis, primary biliary cholangitis, polymyositis, Graves' disease, and idiopathic thrombocytopenic purpura [3], Autoimmune hepatitis (AIH) is rarely seen in PLWH but has been reported as becoming clinically apparent during immune reconstitution (IRS) following the commencement of antiretroviral treatment (ART) [4], It has been suggested that this may be because HIV can cause immune dysregulation, leading to pathogenic processes involved in tire development of a proinflammatory state, facilitating autoimmune systemic diseases [5], However, ART, along with treatments for concomitant opportunistic infections, such as antituberculosis medication, can result in drug-induced liver injury (DILI) [6], Whilst AIH responds well to immunosuppression, DILI may not. [...]early diagnosis of AIH is essential; notwithstanding, it can be difficult in tire context of HIV, HIV-related comorbidities, and their treatment [7, 8], We presented three cases of AIH in the setting of HIV and discussed their history and management. The pretreatment AIH score was 19 (definite) (revised International Autoimmune Hepatitis Group diagnostic criteria) [9] and 7 (likely) (simplified criteria) [10], Liver biopsy (June, 2020) was suggestive of AIH, moderate plasma lymphocytic infiltration with mild-moderate interface hepatitis, hepatocyte rosette and emperipolesis, and advanced fibrosis (early cirrhosis). Prednisolone was weaned to 5 mg in accordance with the American Association for the Study of Liver Diseases [11] and British Society of Gastroenterology guidelines [12], after which she was commenced on azathioprine 50 mg OD (Fig. la). Though a component of efavirenz DILI could not be excluded, it seemed unlikely, a two-year interval between commencing the drug and the development of abnormal liver tests as well as the presence of bridging fibrosis.