Autoimmune hepatitis in an HIV-infected patient: an intriguing association

Abnormal levels of liver enzymes are common in HIV-infected patients and may be caused by multiple factors, including co-infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) infection and in the majority of cases by antiretroviral drug-related liver injury. This report, however, describes a patient with HIV infection and abnormal liver function tests where further diagnostics revealed concomitant autoimmune hepatitis (AIH). The association of immune dysfunction in patients with HIV infection/AIDS and the development of autoimmune diseases is intriguing. The precise mechanism causing the emergence or unmasking of autoimmune conditions in HIV infection remains unclear, but it is important to demonstrate that autoimmune diseases do occur in HIV-infected patients. Therefore, clinicians should include AIH in the differential diagnosis of increased liver enzymes when there is no improvement despite changing antiretroviral therapy.