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Autoimmune hepatitis (AIH) is rarely reported in people living with HIV (PLWH). We describe a group of PLWH who met the diagnostic criteria for AIH, although we believe in the majority this was ‘Drug-induced autoimmune-like hepatitis’ (DI-ALH), which is indistinguishable from AIH. This was caused by Efavirenz (EFZ), an NNRTI which is used globally and not a known cause of DI-ALH.We conducted a retrospective cohort study of PLWH referred to a tertiary center HIV/liver clinic between 2009 – 2015. 9 patients with a histologically confirmed AIH were identified. Demographics, lab values and histology were collated.We reviewed 9 patients with histologically confirmed AIH. A single histopathologist reviewed all biopsy samples and found they were indistinguishable from AIH – as expected with DI ALH. 3 patients, 61M black-African, 35F Asian and 59F black-British, on EFZ at presentation with AST 113 IU/L, ANA 1:640, IgG 19.1 g/L and AST 133 IU/L, Anti SMA 1:160, IgG 21.8 g/L and AST 165 IU/L, ANA 1:320, IgG 26.11 g/L respectively. Biopsy confirmed all cases in keeping with AIH. EFZ was discontinued; transaminases, auto-antibodies and IgG returned to normal with no further treatment. 2 patients, 56F black-African and 47F black-African, on EFZ at presentation with raised AST 196 IU/L, Anti-SMA 1:80, IgG 26.5 g/L and AST 212 IU/L, ANA 1:1280, IgG 30 g/L, respectively. Biopsy confirmed both cases in keeping with AIH and steroids and azathioprine (AZA) were commenced. In the interim, EFZ was switched to raltegravir in both cases. After 10 and 5 years of immunosuppression, AZA was discontinued with no subsequent flare. 2 female patients, 50F black African and 55F black-African, meeting diagnostic criteria for AIH were not on EFZ at diagnosis. 2 patients, 76F white and 70F white, were on EFZ at AIH diagnosis but had personal history of autoimmune disease and advanced fibrosis. All four remain on immunosuppressant.5/9 cases of DI-ALH in HIV patients are in keeping with DI-AIH caused by efavirenz. Removal of EFZ resulted in resolution of transaminases or maintained remission after stopping AZA. Globally, 18 publications have documented 53 cases of AIH in PLWH and in 33/53 cases the patient was on EFZ. Whilst acknowledging historically high prescribing of EFZ, we believe that Efavirenz is a previously unknown cause of DI-ALH. Awareness is important and further cases should be recorded. This could spare a numerically significant minority of PLWH unnecessary lifelong immunosuppression.