The spectrum of liver diseases in HIV infected individuals at an HIV treatment clinic in Kampala, Uganda

Afr Health Sci. 2008 Mar;8(1):8-12.


Background: Liver diseases are common in patients with HIV due to viral hepatitis B and C co-infections, opportunistic infections or malignancies, antiretroviral drugs and drugs for opportunistic infections.

Objective: To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala, Uganda.

Method: Consecutive patients presenting with jaundice, right upper quadrant pain with fever or malaise, ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease.

Results: Seventy-seven consecutive patients were recruited over an eleven month period. Of these, 23 (30%) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61%) patients with drug-induced liver disease presented with jaundice, all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15%) patients while anti-hepatitis C antibody was reactive in only 2 (3%). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9%) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease, AIDS cholangiopathy, hepatocellular carcinoma, schistosomiasis, haemangioma and hepatic adenoma. Twelve (16%) patients died during follow-up of which 7 (9%) died because of liver disease.

Conclusion: Drug history, liver enzyme studies, ultrasound, and hepatitis B and C investigations identified the probable etiology in 60 (78%) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / adverse effects*
  • Antitubercular Agents / adverse effects*
  • Chemical and Drug Induced Liver Injury
  • Comorbidity
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Humans
  • Immunocompromised Host
  • Incidence
  • Isoniazid / adverse effects*
  • Liver Diseases / diagnosis
  • Liver Diseases / epidemiology*
  • Liver Diseases / etiology
  • Liver Diseases / therapy
  • Liver Neoplasms / epidemiology
  • Male
  • Nevirapine / adverse effects*
  • Prevalence
  • Reverse Transcriptase Inhibitors / adverse effects*
  • Time Factors
  • Treatment Outcome
  • Tuberculosis / drug therapy
  • Tuberculosis / epidemiology
  • Uganda


  • Anti-HIV Agents
  • Antitubercular Agents
  • Reverse Transcriptase Inhibitors
  • Nevirapine
  • Isoniazid