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AIDS cholangiopathy

Dr David Minks and Dr Frank Gaillard et al.

AIDS cholangiopathy refers to an acalculus, secondary (likely) oppotunistic cholangitis which occurs in AIDS patients as result of immunosuppression.

Pathology

Characterised by multiple irregular narrowings essentially indistinguishable from primary sclerosing cholangitis (PSC).

Postulated causative orgasnisms include

Cytomegalovirus (CMV)
Herpes simplex virus (HSV)
Cryptosporidium parvum
Microsporidium
Mycobacterium avium complex

No definite organism is identified in up to 1/2 of patients. It typically affects patients with low CD4 counts (<135/mm³).

There are four pathological patterns

combination of sclerosing cholangitis and papillary stenosis : ≈ 50%
isolated intrahepatic sclerosing cholangitis–like appearance ≈ 20%
isolated papillary stenosis : ≈ 15%
long-segment extrahepatic duct stricture + / - concurrent intrahepatic disease ≈ 15%