Autoimmune Hepatitis in People Living with HIV: A Case Series and Review of Literature

Autoimmune immune disorders are rare in people living with human immunodeficiency virus (HIV), especially autoimmune-related liver disease. Additionally, diagnosis is challenging as there can be multiple reasons for abnormal liver tests in people living with HIV. Since autoimmune hepatitis responds well to immunosuppression and delaying treatment can be detrimental, its diagnosis and treatment must not be delayed or missed. To increase awareness amongst clinicians, thus ensuring prompt diagnosis and treatment, we present three patients with autoimmune hepatitis in the context of people living with HIV.

Three individuals aged between 47-63 years (two females and one male) present with significant transaminitis (alanine aminotransferase 5-10 x upper limit of normal), with two out of the three being autoantibody-positive with an elevated IgG. In all three individuals, a liver biopsy was consistent with autoimmune hepatitis and, in addition, showed advanced hepatic fibrosis/cirrhosis. All individuals presented following immune reconstitution. There was a good response to immunosuppression with a reduction in hepatic fibrosis. All are currently in clinical and biochemical remission.

Autoimmune hepatitis, though rare, must be considered in the differential diagnosis of abnormal liver tests in people living with human immunodeficiency virus. There should be a low threshold to perform a liver biopsy, which can be diagnostic in the right clinical setting. A prompt institution of immunosuppression is warranted to induce remission and attenuate hepatic fibrosis. However, long-term management and outcomes, including the duration of immunosuppression, remain unclear.