AIDS cholangiopathy refers to an acalculous, secondary opportunistic cholangitis that occurs in AIDS patients as a result of immunosuppression 1.
Pathology
Characterised by multiple irregular strictures essentially indistinguishable from primary sclerosing cholangitis (PSC). There are four pathological patterns 1,2:
- a 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%)
Aetiology
No definite organism is identified in up to half of the patients. It typically affects patients with low CD4 counts (<135/mm3). Postulated causative organisms include 2:
- cytomegalovirus (CMV)
- herpes simplex virus (HSV)
- Cryptosporidium parvum
- Microsporidium
- Mycobacterium avium complex
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