Persaud D, Bangaru B, Greco M A, Nachman S, Mittal K, Chandwani S, Krasinski K, Borkowsky W, Kaul A
Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, New York 10016.
Pediatr Infect Dis J. 1993 Jun;12(6):492-8. doi: 10.1097/00006454-199306000-00007.
A distinct clinical syndrome of cholestasis and hepatitis occurred during early infancy in seven infants with perinatally acquired human immunodeficiency virus 1 infection. In five infants hepatitis was the first manifestation of human immunodeficiency virus 1 infection. The median age of onset of hepatitis was 7 months (range, 5 to 10 months). The mean total bilirubin concentration at presentation was 7.4 mg/dl (range, 3.9 to 11 mg/dl), the mean aspartate aminotransferase was 1512 IU/liter (range, 782 to 2960 IU/liter) and the mean alanine amino-transferase 512 IU/liter (range, 92 to 1247 IU/liter). The absolute CD4 count at the time of onset of hepatitis ranged from 191 to 2298 cells/mm3 (mean, 766 cells/mm3). Six of the seven children died within 12 weeks of onset of hepatitis, three as a result of complications of Pneumocystis carinii pneumonia, and two died of complications secondary to cytomegalovirus. In only one infant was the cause of death the direct consequence of liver failure. The seventh infant died 17 months after the onset of hepatitis of dilated cardiomyopathy. No specific etiologic agent has been identified as the cause of cholestatic hepatitis in these infants. In situ hybridization studies to detect human immunodeficiency virus 1 messenger RNA was negative in the liver tissue obtained at biopsy and autopsy in five of the samples tested.
七名围产期感染人类免疫缺陷病毒1型的婴儿在婴儿早期出现了明显的胆汁淤积和肝炎临床综合征。在五名婴儿中，肝炎是人类免疫缺陷病毒1型感染的首发表现。肝炎发病的中位年龄为7个月（范围为5至10个月）。就诊时平均总胆红素浓度为7.4mg/dl（范围为3.9至11mg/dl），平均天冬氨酸转氨酶为1512IU/升（范围为782至2960IU/升），平均丙氨酸转氨酶为512IU/升（范围为92至1247IU/升）。肝炎发病时的绝对CD4细胞计数范围为191至2298个细胞/mm3（平均为766个细胞/mm3）。七名儿童中有六名在肝炎发病后12周内死亡，三名死于卡氏肺孢子虫肺炎并发症，两名死于巨细胞病毒继发并发症。只有一名婴儿的死亡原因是肝衰竭的直接后果。第七名婴儿在肝炎发病17个月后死于扩张型心肌病。尚未确定这些婴儿胆汁淤积性肝炎的具体病因。在检测的五个样本中，用于检测人类免疫缺陷病毒1型信使核糖核酸的原位杂交研究在活检和尸检获得的肝组织中均为阴性。
