DIAGNOSTIC-VALUE OF LIVER-BIOPSY IN SYMPTOMATIC HIV-1-INFECTED PATIENTS

Objective: To evaluate the diagnostic value and risk of liver biopsy in symptomatic human immunodeficiency virus (HIV) infected individuals with hepatomegaly and/or abnormal liver function tests. Methods and patients: Retrospective analysis of 25 consecutive HIV-infected patients undergoing liver biopsy with respect to indication, use of medication, diagnostic yield and complications in the period 1984-1989 in an academic hospital, drawn from a population of 550 HIV-infected persons under care during the study period. Results: In 18 patients (72%), liver biopsy was explanatory for the underlying liver disease. Histopathologic features compatible with drug-induced liver disease was found in nine patients (36%). In four others, mycobacterial infection was diagnosed, in one cytomegalovirus infection, in another acute hepatitis C and in another histoplasmosis. Two patients (8%) died as a direct consequence of the biopsy. Pattern of liver function test did not predict histopathologic diagnosis. Conclusion: Liver biopsy makes an important contribution to the understanding of underlying liver pathology in symptomatic HIV-infected patients and is the fastest method for diagnosis of viral or mycobacterial liver involvement. Drug-induced liver injury was unexpectedly common. Risks are considerable, however, necessitating careful consideration of indication.