CHOLESTASIS IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME - A SURGEONS PERSPECTIVE

Cholestasis is a common finding in patients with acquired immunodefici ency syndrome. The underlying causes may be related to intrahepatic pr ocesses, cholecystitis, papillary stenosis, or sclerosing cholangitis. Published reports of hepatobiliary diseases in patients with acquired immunodeficiency syndrome are reviewed. The etiological factors are c onsidered, and available therapeutic approaches are discussed. Hepatic causes of cholestasis indicate poor prognosis, and effective treatmen ts are not yet available. Cholecystitis, often acalculous in origin, r emains a surgical disease. Endoscopic sphincterotomy appears to give g ood results in the treatment of papillary stenosis. Although a standar d approach to sclerosing cholangitis has not been established, a trial of appropriate antibiotics may be beneficial. Frequently, the cause o f cholestasis is multifactorial in these patients; thus, a coherent th erapeutic approach is essential for optimal clinical results.