Minireviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2018; 24(7): 767-774
Published online Feb 21, 2018. doi: 10.3748/wjg.v24.i7.767
Epidemiology, determinants, and management of AIDS cholangiopathy: A review
Maliha Naseer, Francis E Dailey, Alhareth Al Juboori, Sami Samiullah, Veysel Tahan
Maliha Naseer, Francis E Dailey, Alhareth Al Juboori, Sami Samiullah, Veysel Tahan, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Veysel Tahan, MD, FACP, FACG, FESBGH, Assistant Professor of Clinical Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States. tahanv@health.missouri.edu
Telephone: +1-573-8846044 Fax: +1-573-8844595
Received: December 25, 2017
Peer-review started: December 25, 2017
First decision: January 4, 2018
Revised: January 24, 2018
Accepted: February 1, 2018
Article in press: February 1, 2018
Published online: February 21, 2018
Processing time: 46 Days and 8.6 Hours
Abstract

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

Keywords: Prognosis; Human immunodeficiency virus complications; Epidemiology; Human immunodeficiency virus cholangiopathy; Acquired immunodeficiency syndrome; Mortality

Core tip: Though a declining phenomenon in the Western world, acquired immunodeficiency syndrome (AIDS)-related cholangiopathy has been shown to cause significant burden and remains an important etiology of hepatobiliary pathology in those affected with human immunodeficiency virus (HIV). While it is linked to advanced immunosuppression in AIDS patients, particularly in those with extremely low CD4 counts and opportunistic infections, as well as those with drug-resistant HIV infection, it is also seen in developing countries due to less available anti-retroviral therapy, decreased awareness, and medication non-compliance.