Epidemiology, determinants, and management of AIDS cholangiopathy: A review

World J Gastroenterol. 2018 Feb 21;24(7):767-774. doi: 10.3748/wjg.v24.i7.767.

Abstract

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

Keywords: Acquired immunodeficiency syndrome; Epidemiology; Human immunodeficiency virus cholangiopathy; Human immunodeficiency virus complications; Mortality; Prognosis.

Publication types

  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / microbiology
  • AIDS-Related Opportunistic Infections / therapy
  • Analgesics, Opioid / therapeutic use
  • Anti-HIV Agents / therapeutic use
  • Bile Duct Diseases / diagnosis
  • Bile Duct Diseases / epidemiology*
  • Bile Duct Diseases / microbiology
  • Bile Duct Diseases / therapy
  • Biliary Tract / diagnostic imaging
  • Biliary Tract / microbiology
  • Biliary Tract / pathology
  • Biliary Tract Surgical Procedures
  • Cryptosporidium / drug effects
  • Cryptosporidium / isolation & purification
  • Cryptosporidium / physiology*
  • Drug Resistance
  • HIV-1 / drug effects
  • HIV-1 / physiology*
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology
  • Liver / virology
  • Nerve Block / methods

Substances

  • Analgesics, Opioid
  • Anti-HIV Agents