CASE REPORT


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



Obeng Laurenda1, Patel Anneka1, Villa Giovanni2, Mourad Adele1, 5, Whibley Max3, Gilleece Yvonne2, 4, Verma Sumita1, 4, 5, *
1 Department of Gastroenterology and Hepatology, University Hospitals Sussex, Brighton, UK
2 Lawson Unit, University Hospitals Sussex, Brighton, UK
3 Department of Histopathology, University Hospitals Sussex, Brighton, UK
4 Department of Global Health and Infection, Brighton & Sussex Medical School, UK
5 Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK


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Creative Commons License
© 2023 Laurenda et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Brighton and Sussex Medical School, Main Teaching Building, Room 2.17, North South Road, Falmer, UK, Brighton, BN1 9PX; Tel: +44 (0)1273 877890; Fax: +44 (0) 1273 877856; E-mail: s.verma@bsms.ac.uk


Abstract

Background:

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.

Case Presentation:

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.

Conclusion:

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.

Keywords: Abnormal liver tests, Cirrhosis, Interphase hepatitis, Autoimmune-related liver disease, Remission, Azathioprine.