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Biliary Problems in People with HIV Disease.

Walden1

  • 1Division of Gastroenterology, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Box 8124, St. Louis, MO 63110.

Current Treatment Options in Gastroenterology
|November 30, 2000
PubMed
Summary

Gallstones are a common cause of acute cholecystitis in HIV patients. While cholecystectomy can relieve pain, HIV cholangiopathy may cause persistent symptoms, sometimes requiring endoscopic retrograde cholangiopancreatography (ERCP).

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Hepatology

Background:

  • Antiretroviral therapy has made biliary problems in HIV patients similar to those in non-immunosuppressed individuals, primarily gallstone-related.
  • Acute cholecystitis in HIV patients presents diagnostic challenges, with potential complications like HIV cholangiopathy.

Purpose of the Study:

  • To outline diagnostic and management strategies for acute cholecystitis in HIV-infected patients.
  • To differentiate gallstone-induced cholecystitis from HIV cholangiopathy and guide treatment decisions.

Main Methods:

  • Review of clinical presentations and diagnostic approaches for biliary tract disease in HIV patients.
  • Discussion of the role of abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) in diagnosis and management.

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  • Consideration of perioperative risks and outcomes in HIV-infected patients undergoing biliary procedures.

    • Main Results:

    • Gallstones are the predominant cause of cholecystitis in HIV patients on antiretroviral therapy.
    • HIV cholangiopathy, a complication of severe immunosuppression, affects about half of patients and can lead to persistent symptoms post-cholecystectomy.
    • ERCP with sphincterotomy is effective for symptomatic papillary stenosis but less beneficial for asymptomatic elevated liver enzymes in HIV patients.

    Conclusions:

    • Management of acute cholecystitis in HIV patients requires careful consideration of gallstone disease versus HIV cholangiopathy.
    • While cholecystectomy can be effective, the potential for concurrent HIV cholangiopathy necessitates patient counseling regarding possible ongoing symptoms and need for ERCP.
    • ERCP is recommended for symptomatic papillary stenosis but should be used judiciously for asymptomatic liver enzyme elevations in HIV patients due to limited benefits and risks.