Kahraman Alisan, Miller Michael, Gieseler Robert K, Gerken Guido, Scolaro Michael J, Canbay Ali
Department of Gastroenterology and Hepatology, University Hospital, University of Duisburg-Essen, Germany.
Eur J Gastroenterol Hepatol. 2006 Jan;18(1):101-5. doi: 10.1097/00042737-200601000-00018.
Non-alcoholic fatty liver disease is a prominent feature in HIV-positive patients. We present two patients with long-lasting HIV-infection who suffered from this disease, as induced by highly active anti-retroviral therapy (HAART). The patients developed acute-on-chronic (AOC) liver failure after either (case 1) acute infection with hepatitis A virus (HAV) or (case 2) methamphetamine abuse ('Ecstasy'). Approximately 1 week after visiting an area endemic for HAV, case 1, a male patient, presented with icterus, elevated liver transaminases and HAV IgM. Previous examinations had demonstrated normal liver transaminase activities while hepatic steatosis had been suspected. He developed complications associated with liver failure including renal failure as well as pleural and pericardial effusions. Case 2, a second male patient, developed both liver failure and lactic acidosis 24 h after methamphetamine abuse. Both patients suffered from fatty liver in the pre-acute stage as indicated by ultrasound examination. After developing symptoms of liver failure, HAART was discontinued in both patients. Follow-up visits demonstrated that the patients recovered clinically with almost normalized laboratory parameters. In HIV infection, HAART-induced hepatopathological alterations may exist despite the absence of relevant laboratory parameters. These patients are likely to develop AOC liver failure when subjected to acute risk factors such as hepatitis viruses and narcotics or other drugs. In patients treated with HAART, we thus highly recommend hepatitis A and B virus vaccinations, and close monitoring of liver parameters.
非酒精性脂肪性肝病是HIV阳性患者的一个显著特征。我们报告了两名长期感染HIV且患有这种疾病的患者，病因是高效抗逆转录病毒疗法（HAART）。这两名患者在（病例1）感染甲型肝炎病毒（HAV）或（病例2）滥用甲基苯丙胺（“摇头丸”）后发生了急性-on-慢性（AOC）肝衰竭。病例1是一名男性患者，在前往HAV流行地区约1周后，出现黄疸、肝转氨酶升高和HAV IgM阳性。此前检查显示肝转氨酶活性正常，但怀疑有肝脂肪变性。他出现了与肝衰竭相关的并发症，包括肾衰竭以及胸腔和心包积液。病例2是另一名男性患者，在滥用甲基苯丙胺24小时后出现肝衰竭和乳酸酸中毒。超声检查显示，两名患者在急性发作前阶段均患有脂肪肝。出现肝衰竭症状后，两名患者均停用了HAART。随访显示，患者临床康复，实验室参数几乎恢复正常。在HIV感染中，尽管缺乏相关实验室参数，但可能存在HAART诱导的肝脏病理改变。当这些患者受到肝炎病毒、麻醉品或其他药物等急性危险因素影响时，很可能会发生AOC肝衰竭。因此，对于接受HAART治疗的患者，我们强烈建议接种甲型和乙型肝炎病毒疫苗，并密切监测肝脏参数。
