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Narrowing of the Bile Ducts Due to AIDS

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by Ali A. Siddiqui, MD

People with AIDS tend to develop certain unusual infections because their immune system is weakened. Such infections are called opportunistic infections because they take advantage of a weakened immune system. These infections can cause the bile ducts to narrow—a disorder called AIDS cholangiopathy. Usually, the ducts eventually become inflamed and scarred.

Before drugs to treat HIV infection (antiretroviral therapy) were widely used, AIDS cholangiopathy developed in about one fourth of people with AIDS.

The disorder causes pain in the upper right and upper middle parts of the abdomen. If the infection affects the small intestine, people also have diarrhea. A few people have fever and jaundice (a yellowish discoloration of the skin and whites of the eyes).

Diagnosis

Endoscopic retrograde cholangiopancreatography (ERCP) may be done to confirm the diagnosis because it enables doctors to take a sample of infected tissue for examination under a microscope. Then doctors can identify the organism causing the infection. During ERCP, doctors can also widen (dilate) the narrowed bile ducts and thus relieve symptoms. For ERCP, a flexible viewing tube (endoscope) with surgical attachments is passed through the mouth, down the esophagus, through the stomach, and into the small intestine (see Figure: Understanding Endoscopic Retrograde Cholangiopancreatography). A thin catheter is passed through the endoscope, through the ring-shaped muscle between the common bile and pancreatic ducts and small intestine (sphincter of Oddi), and up into the common bile duct. A dye that is visible on x-rays (radiopaque dye) is then injected through the catheter into the bile ducts, and x-rays are taken to detect any abnormalities.

Alternatively, ultrasonography may be done to help confirm the diagnosis. It is less invasive and is very accurate.

Blood tests to determine how well the liver is functioning and whether it is damaged (liver function tests) are usually also done. The results can support the diagnosis.

Treatment

During ERCP, a surgical instrument is passed through the endoscope and used to cut the sphincter of Oddi—a procedure called endoscopic sphincterotomy. Cutting the sphincter of Oddi allows bile to pass into the small intestine. This procedure helps relieve pain, jaundice, and inflammation. If only one part of a duct is narrowed, a tube may be passed through the endoscope and placed in the affected spot to widen it.

Antimicrobial drugs are given to treat the infection.