Abdominal pain is usually associated with nausea, vomiting, and fever. Jaundice is rarely seen in AIDS cholangiopathy. Other hepatic enzyme levels can be abnormal in patients with AIDS cholangiopathy, but this finding is not specific. Bilirubin level is usually normal, hence there is typically no jaundice present on physical examination. Findings consistent with sclerosing cholangitis on transabdominal ultrasound include: Dilated intrahepatic bile ducts Stenosis Thickening of the common bile duct wall If any of these findings are identified in a patient with AIDS, endoscopic retrograde cholangiopancreatography ERCP is indicated. Sclerosing cholangitis, intrahepatic sclerosing cholangitis, and extrahepatic bile duct strictures are usually evident on ERCP in patients with AIDS cholangiopathy.
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Metrics details Opinion statement AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated.
Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy. Four distinct cholangiographic abnormalities have been demonstrated by endoscopic retrograde cholangiopancreatography, the most common being papillary stenosis with sclerosing cholangitis.
Antimicrobial therapy is often ineffective. Highly active antiretroviral therapy may enhance immune function and offers the best medical therapy to clear the opportunistic infections. Ursodeoxycholic acid has a limited benefit in patients with sclerosing cholangitis and cholestasis. Endoscopic sphincterotomy has been shown to relieve pain and biliary obstruction in patients with papillary stenosis.
Balloon dilation of strictures and stent placement decompress the biliary system and may be helpful. Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain. This is a preview of subscription content, log in to check access. Access options Instant access to the full article PDF. Subscription will auto renew annually.
AIDS Cholangiopathy — Diagnosis and Treatment