HIV in Children
Liver disease in an HIV infected child
Ira Shah
Professor and Head, Pediatric Infectious Diseases and Pediatric Gastroenterology, B J Wadia Hospital for Children, Mumbai, India.
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India.

A 6 years old HIV infected boy presented with intermittent cough for 2 years. His mother had died of AIDS and pulmonary TB 2 years ago. On examination, the child was malnourished (weight = 12 kg, height = 98 cm), had bilateral crepitations and hepato- splenomegaly. Investigations showed:
• Hemoglobin = 9.8 gm/dl
• WBC count = 4,700/cumm [66% polymorphs, 32% lymphocytes]
• ESR = 57 mm of Hg
• SGPT = 90 IU/L
• SGOT = 115 IU/L
• Amylase = 37 IU/L
• Chest X-Ray = Left lower zone haziness
• USG Abdomen = Hepatosplenomegaly with fatty liver.
• CD4 count = 349 (18.5%)
• HBsAg, HCV = Negative

He was treated with antibiotics and pneumonia responded. He was then put on 3 drugs antiretroviral therapy (ART) consisting of abacavir (ABC), lamivudine (3TC) and efavirenz (EFV). After 2 months, his weight was the same and SGPT was 105 IU/L, albumin, bilirubin and prothrombin time was normal. After another month, he was admitted with severe metabolic acidosis and pulmonary bleed and died due to the same.

What was the cause of liver disease in this child?
See Previous Teaching Files
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Infection in Children - Part 2

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Case Rounds in Pediatric Liver Disorders
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Management of Pediatric HIV
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Infection in Children
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