Although liver test abnormalities are frequently iden-aminases, alkaline phosphatase) have been found in tified in patients with acquired immunodeficiency synup to two thirds of patients at some point during the drome (AIDS), the causes, evaluation, and outcome of course of disease. 1 Hepatomegaly may be detected by jaundice in these patients have not been systematically physical examination in up to 73% of patients. 1 These evaluated. From August 1, 1990 through September 1, disorders result from a variety of opportunistic infec-1994, all human immunodeficiency virus (HIV)-infected tions or neoplasms, as well as drug-induced liver dispatients with liver test abnormalities seen by the gastroease, alcohol use, or some combination of these facenterology service at a large, inner-city hospital were tors. [2][3][4][5][6][7][8] Although abnormal liver biochemical tests are prospectively identified. Jaundice was defined as a secommon, jaundice appears to be unusual. The purpose rum bilirubin concentration Β’3 mg/dL. The etiology of of our study was to evaluate the prevalence, causes, jaundice was determined by the pattern of liver biochemistry test abnormalities, radiographic studies, liver and outcome of jaundice in patients with AIDS, as well biopsy, clinical follow-up, and autopsy. During the study as the results of diagnostic tests.
period, 541 HIV-infected patients (511 with AIDS) were PATIENTS AND METHODS evaluated for liver disease by our service; 36 of these patients had jaundice (7%). The most common causes of
The study group was collected prospectively from in-pajaundice were drug-induced hepatitis, occurring in 11 tients evaluated by the Emory University gastroenterology patients (31%), and alcoholic liver disease, occurring in consultative service at Grady Memorial Hospital during the 5 (13%). Opportunistic infections or neoplasms were period August 1, 1990 through September 1, 1994. This hospiidentified as the cause of jaundice in 11 patients (30%), tal is a 1,000-bed city-county hospital serving primarily the with 4 having intrahepatic disease and 7 having extraheindigent population of metropolitan Atlanta, Georgia. During patic disease. Multiple potential causes were seen in 3 the study period, all in-patients with documented human impatients. Abdominal ultrasonography (US) and communodeficiency virus (HIV) infection seen for consultation puted tomography (CT) were helpful in suggesting the had the reason for that consultation documented on a stanunderlying cause of disease. The short-term mortality dardized form. All patients underwent initial evaluation with was high, with 9 patients dying during the hospitalizaeither abdominal ultrasonography (US) or computed tomogtion (25%) and 7 patients dying within 6 months of evaluraphy (CT). The subsequent diagnostic evaluation was not ation. Liver disease was the cause of death in 7 of these standardized but was dependent on the results of abdominal patients. In conclusion, jaundice is uncommon in AIDS imaging and the clinical setting. and may result from a variety of both opportunistic and Jaundice was defined as a serum bilirubin concentration non-opportunistic etiologies. Drug-induced hepatitis is Β’3 mg/dL. For identified patients, the highest value of serum the most common cause and may be fatal. Long-term bilirubin at or before the time of consultation was used for survival was poor. (HEPATOLOGY 1996;23:728-733.) the analysis. At the time of the recorded bilirubin level, other liver biochemistry tests were similarly recorded. The cause(s) Patients with acquired immunodeficiency syndrome of jaundice was determined by the clinical history, pattern (AIDS) frequently have biochemical, serological, or of liver biochemistry test abnormalities, findings on radio- morphological evidence of parenchymal liver disease. graphic studies (including US,CT, percutaneous transhepatic Significant increases in liver biochemistry tests (transcholangiography, endoscopic retrograde cholangiopancrea- tography (ERCP), percutaneous liver biopsy, and clinical follow-up including liver biochemical tests), and postmortem Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human examination. Drug-induced hepatitis was considered to be immunodeficiency virus; US, ultrasonography; CT, computed tomography; etiologic when (A) the patient was administered a drug recog-ERCP, endoscopic retrograde cholangiopancreatography; MAC, Mycobacterium avium complex; KS, Kaposi's sarcoma. nized as causing hepatitis associated with liver biochemistry From the Department of Medicine (Division of Digestive Diseases), Emory tests compatible with hepatitis, and (B) where drug with-