Cholestasis in patients with acquired immunodeficiency syndrome: a surgeon's perspective

Cholestasis is a common finding in patients with acquired immunodeficiency syndrome. The underlying causes may be related to intrahepatic processes, cholecystitis, papillary stenosis, or sclerosing cholangitis. Published reports of hepatobiliary diseases in patients with acquired immunodeficiency syndrome are reviewed. The etiological factors are considered, and available therapeutic approaches are discussed. Hepatic causes of cholestasis indicate poor prognosis, and effective treatments are not yet available. Cholecystitis, often acalculous in origin, remains a surgical disease. Endoscopic sphincterotomy appears to give good results in the treatment of papillary stenosis. Although a standard approach to sclerosing cholangitis has not been established, a trial of appropriate antibiotics may be beneficial. Frequently, the cause of cholestasis is multifactorial in these patients; thus, a coherent therapeutic approach is essential for optimal clinical results.