
Successful Management of Newly Diagnosed Autoimmune Hepatitis in a Long-term HIV Survivor: A Case Report
OD04-OD06
Correspondence
Dr. Nimmagadda Panindra,
Resident, Department of General Medicine, Dr. D. Y. Patil Medical College, Pune-411018, Maharashtra, India.
E-mail: panindra1994@gmail.com
Autoimmune Hepatitis (AIH) is a chronic inflammatory liver disease characterised by the presence of circulating autoantibodies, hypergammaglobulinemia and interface hepatitis on histological examination. AIH in Human Immunodeficiency Virus (HIV)-positive patients presents a unique diagnostic and therapeutic challenge due to the complex interplay between immune activation and immunodeficiency. Treatment considerations in such cases require a careful balance between immunosuppression for AIH and maintaining adequate immune function for HIV control. A 67-year-old female with a 30-year history of well-controlled HIV infection presented with jaundice and haematemesis. Initial evaluation revealed hypotension and abnormal liver function tests. Imaging studies demonstrated portal hypertension with oesophageal varices, requiring endoscopic variceal ligation. Serological work-up showed positive antinuclear antibodies (1:320), elevated Immunoglobulin G (IgG) levels (2270 mg/dL) and positive Anti-mitochondrial-M2 (AMA-M2), with a normal Cluster Differentiation (CD4) count (802/mm3). A liver biopsy confirmed AIH with advanced fibrosis (score 6/6) and significant portal plasmacytosis. The patient was initiated on steroid therapy, which led to clinical improvement. At the three-month follow-up, liver function tests showed significant improvement, with total bilirubin decreasing from 6.56-3.56 mg/dL, AST from 166-80 U/L and ALT from 152-79 U/L. The patient maintained stable HIV control throughout the treatment period. The present case demonstrates that AIH can be successfully managed with standard immunosuppressive therapy in HIV-positive patients with well-controlled disease, highlighting the importance of considering autoimmune conditions in the differential diagnosis of liver dysfunction in HIV patients.