- AIDS cholangiopathy is a syndrome of biliary obstruction due to biliary tract infection, with the most common infections including Microsporidium, CMV and cyclospora.
- It usually develops in patients with CD4 well below 100, and most patients present with RUQ/epigastric pain and diarrhea.
- The diarrhea is likely due to small bowel involvement of the infectious agent
- 10-20% will present with fever and jaundice, and others may have severe abdominal pain due to papillary stenosis associated with the cholangiopathy
- Labs will be consistent with cholestasis, usually with very significant alk phos elevation (average is 800, but it was >2300 in this patient!) with mild transaminitis and hyperbilirubinemia
- CT and ultrasound can be helpful first steps to look for bile duct strictures/dilation.
- ERCP is the procedure of choice for diagnosis (can get brushings, biopsy and cholangiography) and for therapeutic intervention with sphincterotomy, if needed.
- Treatment consists mainly of anti-retroviral therapy, as the survival rate of the cholangiopathy is primarily determined by the course of the patient’s HIV/AIDS.
- HIV is not known to increase the risk of shigella infection, but there is a 50-100 fold increase is invasive pneumococcal infection in patients with HIV!