Utility of liver biopsy in HIV-infected patients presenting with febrile illnesses and inconclusive evaluation

Abstract

Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIV- infected patients presenting with febrile illnesses and inconclusive initial investigative work up. Design: A retrospective descriptive study. Setting: The Aga Khan University Hospital, Nairobi. Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007. Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloi d granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260U/L and 304U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72U/L respectively. Conclusion: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV- infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis.