HEPATOBILIARY AND PANCREATIC INFECTIONS IN AIDS - PART II

In the first part of our review, we discussed the general evaluation a nd clinical presentation of the various hepatic infections occurring i n patients with AIDS. In addition, we focused on specific hepatic pare nchymal infections. In this article, we will discuss the major clinica l syndromes arising from opportunistic infections affecting the gallbl adder (acalculous cholecystitis), biliary tree (AIDS-cholangiopathy), and pancreas (pancreatitis). Acalculous cholecystitis can develop in p atients with AIDS who have not experienced the severe precipitating ph ysiologic stresses normally required in patients without AIDS. The mos t common presentation is with right upper quadrant (RUQ) pain and tend erness. The diagnosis is a clinical one since there is no standard tes t, other than surgery. Cholecystectomy is the treatment of choice. The most common AIDS-associated infective complication of the biliary tre e is AIDS-cholangiopathy. This is best viewed as a form of secondary s clerosing cholangitis resulting from a variety of opportunistic infect ions within the biliary tree. Affected persons present with RUQ pain a nd have marked elevations in the canalicular enzymes, alkaline phospha tase, and gamma-glutamyl transferase. Morphologic abnormalities are id entified by endoscopic retrograde cholangiopancreatography. These incl ude stricturing, dilatation, and beading of the biliary tract. Endosco pic sphincterotomy of the papilla of Vater may provide symptomatic rel ief for patients with papillary stenosis. Opportunistic infections wit hin the pancreas gland have been documented in both pre- and postmorte m studies. However, the true incidence of pancreatitis related to infe ctions is unknown. The presentation is similar to that of pancreatitis from other causes. A computerized tomogram of the abdomen is the inve stigation of choice. Tissue aspiration or biopsy of the pancreas is re quired to demonstrate the presence of an opportunistic infection. The management is usually supportive, as it is rare that a specific infect ion is identified and treated.