DIAGNOSIS AND PROGNOSIS OF AIDS-RELATED CHOLANGITIS

Objective: To determine more precisely the clinical and biological cha racteristics of AIDS-related cholangitis, and to investigate prognosti c variables of this disease. Design: Retrospective clinical and progno stic study. Setting: Biliary unit, Bicetre Hospital, France. Patients: HIV-positive patients (n=52) referred to the unit between December 19 86 and June 1993 for biliary symptoms leading to the suspicion of AIDS -related cholangitis, (42 men; 10 women; mean age, 37+/-8 years). Inte rvention: Endoscopic retrograde cholangiopancreatography (ERCP) was pe rformed in order to determine the cause of the biliary symptoms. Main outcome measure: Clinical features and evolution of the cholangitis. R esults: Among the 52 patients, 45 met the ERCP criteria of AIDS-relate d cholangitis (36 men; nine women). The diagnosis of cholangitis was s trongly suggested by abdominal ultrasonography in 47% of the cases. ER CP showed papillary stenosis, diffuse cholangitis, extrahepatic cholan gitis alone, and intrahepatic cholangitis alone in 60, 67, 7 and 27%, respectively. Endoscopic sphincterotomy was performed in 28 patients. Pain was relieved by sphincterotomy in nine patients, but the other cl inical or biological features were not influenced. One-year and 2-year survival rates were 41+/-7% and 8+/-4%, respectively. Multidimensiona l analysis using a Cox model showed that a lymphocyte count >500x10(6) /l was the only independent predictive factor of better survival. Conc lusion: AIDS-related cholangitis is a disease which leads preferential ly to papillary stenosis or diffuse abnormalities of the biliary tract . Prognostic factors depend on the stage of the HIV infection. Another diagnosis of cholestasis was found in approximately 15% of the patien ts who showed biliary symptoms.