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 HIVinfected 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 epitheloid 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.

East African Medical Journal Vol. 85 (10) 2008: pp. 505-508