Liver disease is the leading cause of non-AIDS related morbidity and mortality in human immunodeficiency virus (HIV) infected patients. There are many causes of liver disease in these patients, most commonly co-infection with viral hepatitis or alcoholic liver disease. A far less commonly described entity is autoimmune hepatitis (AIH) in HIV patients. The relationship between HIV and autoimmune diseases is well-described in a few conditions such as systemic lupus erythematosus and diffuse infiltrative lymphocytosis syndrome; however, patients with HIV who subsequently develop autoimmune hepatitis (AIH) has rarely been described in the existing literature. Managing these coexisting morbidities requires careful monitoring, as treating AIH requires the further immunosuppression of an HIV-infected individual. Herein, we present two patients who were diagnosed with and treated for AIH while receiving concurrent highly active anti-retroviral therapy. This case series provides treatment outcome data for a situation that has heretofore been rarely reported.
Samir Parekh, Zachary Spiritos, Paul Reynolds, Samir Parekh, Adam Perricone and Brian Quigley