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[HEPATOBILIARY INFECTIONS IN AIDS]

The hepatobiliary involvement in AIDS is a relatively frequent phenomenon, especially in advanced stages of immunosuppression. Opportunistic agents such as MAI, CMV, are probably the commonest among patients with CD4 counts below 200/mm3. Chronic viral hepatitis is very prevalent in this population and may acquire particular connotations regarding clinical presentation and natural history. AIDS related cholangiopathy is a syndrome characterized by abnormalities in the billary tree, generally associated with Cryptosporidium parvum, CMV and Microsporidia spp. and has cholangiographic features almost identical to primary sclerosing cholangitis, sometimes requiring endoscopic intervention for paliative purposes.The evaluation of the patient with AIDS and hepatobiliary disease requires a careful and systematic approach, taking into account the use of potentially hepatotoxic medications and the possibility of neoplasms such as non?Hodgkin lymphoma or Kaposi's sarcoma. A liver biopsy is indicated in the evaluation of patients with AIDS and abnormalities in biochemical liver tests in the setting of fever of unknown origin, once all the other less invasive diagnostic tests have been inconclusive, always considering the possibility of diagnosing a treatable condition that will result in an improvement of the quality of life.