II. Epidemiology
- Hepatomegaly occurs in 50% of AIDS patients
III. Differential Diagnosis
- Diffuse hepatocellular disease
- Granulomatous hepatitis
-
Viral Hepatitis (Transaminitis; accelerated course to liver failure in HIV patients)
- Hepatitis B
- Hepatitis C
- Strongly consider Hepatitis C Antiviral Regimen (90% sustained response)
- http://www.hcvguidelines.org/unique-populations/hiv-hcv
- Sclerosing Cholangitis syndrome
- Cytomegalovirus (associated with infectious Pancreatitis)
- Cryptosporidium
- Cholestatic hepatitis (consider occult infection)
- Mycobacterium Avium Complex (MAC)
- Associated with infectious Pancreatitis
- Lab findings include increased Alkaline Phosphatase, Lactate Dehydrogenase (LDH) and Anemia
- Mycobacterium tuberculosis
- Histoplasmosis
- Coccidioidomycosis
- Cryptococcus
- Kaposi's Sarcoma
- Non-Hodgkin's Lymphoma
- HIV-associated Peliosis Hepatitis
- Drug induced cholestasis
- Steatosis (macrovesicular and microvesicular)
- Mycobacterium Avium Complex (MAC)
IV. Labs
- Viral Hepatitis serologies
V. Imaging
- Right Upper Quadrant Ultrasound
- CT Abdomen and Pelvis
- MRCP or ERCP (indicated for signs of biliary obstruction)
VI. Management
- Avoid Hepatotoxins (e.g. Alcohol)
- Manage comorbidities