Human immunodeficiency virus infection and autoimmune hepatitis during highly active anti-retroviral treatment: a case report and review of the literature

We present the case of a 42-year-old African-American woman with human immunodeficiency virus infection who presented to our emergency department with severe abdominal pain and was found to have autoimmune hepatitis. A review of the literature revealed 12 reported cases of autoimmune hepatitis in adults with human immunodeficiency virus infection, only three of whom were diagnosed after highly active anti-retroviral treatment was initiated. All four cases (including our patient) were women, and one had a history of other autoimmune disorders. In our patient (the one patient case we are reporting), a liver biopsy revealed interface hepatitis, necrosis with lymphocytes and plasma cell infiltrates and variable degrees of fibrosis. All four cases required treatment with corticosteroids and/or other immune modulating agents and responded well.Our review suggests that autoimmune hepatitis is a rare disorder which usually develops in women about six to eight months after commencing highly active anti-retroviral treatment during the recovery of CD4 lymphocytes. It represents either re-emergence of a pre-existing condition that was unrecognized or a de novo manifestation during immune reconstitution.Impaired immunity in individuals with human immunodeficiency virus (HIV) infection affects the defense mechanisms against pathogens and alters the regulation of autoimmunity [1]. This may lead to the emergence of autoimmune disorders or modification of pre-existing conditions. Several conditions may remit, such as systemic lupus erythematosus (SLE), while others, such as psoriasis, intensify. The development of liver disease during highly active anti-retroviral treatment (HAART) in patients with HIV infection without evidence of co-infection with hepatitis viruses poses a diagnostic dilemma. This may be due to treatment side effects or to the emergence of autoimmune disorders during immune restoration.Autoimmune hepatitis (AIH) is rare in patients with HIV infection. Additionally