PowerPointPrsentation

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• Acute-on-chronic liver failure in HIV infection
  two cases
• Canbay1, R. Gieseler2, M. Kullmer1, K. Radecke
  1, B. Ross1,R. Noppeney 1, G. Gerken1, and U.
  Treichel1
• 1 Dept of Gastroenterology and Hepatology,
  Universiy Clinic Essen, and 2 LTBH Medical
  Research Institute, Beverly Hills, CA, USA

Background
Acute liver failure, as charcaterized by acute
liver insufficiency, hepatorenal syndrome, and
hepatic encephalopathy, is termed
acute-on-chronic liver failure (AOC) when
pre-damaged organ is affected. Indeed, gt50 of
all HIV patients present with non-specific
hepatic alterations such steatosis, siderosis,
reactive hepatitis, or cholestasis which are
currently attributed to multifactorial causes. We
here present two patients with long-lasting
HIV-infection under anti-retroviral therapy (ART)
who developed AOC after (i) acute infection with
HAV, or (ii) methamphetamine (Ecstasy) abuse.
Cases
I Approx. 1 wk. after visiting an area endemic
for HAV, a 39-yr.-old male (stage A2) became
icteric, showed elevated liver enzymes, and was
tested IgM-positive for HAV. Previous
examinations had dem-onstrated normal
transaminase activities while hepatic steatosis
had been suspected. He developed liver
failure-associated complications including renal
failure as well as pleural and pericardial
effusion. II A 33-yr.-old male (stage A3),
known for ethanol abuse and suspected alcoholic
liver disease. Approx. 24 hrs. after Ectasy
abuse, he developed both liver failure and lactic
acidosis (12 U/L).
Results
Both patients suffered from fatty liver in the
pre-acute stage as suspected by ultrasound
assessments. After developing symptoms of liver
failure, ART was discontinued. The patients
recovered clinically with normalized laboratory
parameters in follow-up (cf. Tab. 1).
Tab. 1 Virology / Clinical Chemistry /
Hemostaseology
Stage
Sonography
Conclusions
Because in HIV patients the liver may be
pre-damaged despite inapparent laboratory
parameters, such individuals are likely to
develop AOC when subjected to acute risk factors
such as the hepatitis viruses or toxic drugs.
Therefore, firstly, vaccination against
hepatitis A and B should be strongly urged.
Secondly, with respect to ART, liver parameters
have to be closely monitored.