Cholestasis and disseminated cytomegalovirus disease in patients with the acquired immunodeficiency syndrome.

A cholestatic syndrome caused by papillary stenosis and sclerosing cholangitis (PS/SC) has been recently described as a complication of the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus has been implicated as an etiologic factor in this syndrome. Consecutive cases of disseminated cytomegalovirus disease and viremia were reviewed for evidence of cholestasis. In 12 of 36 (33 percent) patients with cytomegalovirus infection (gastrointestinal disease [eight of 16 patients] or retinitis [four of 20 patients]), cholestatic liver enzyme abnormalities developed within three months of the diagnosis of cytomegalovirus disease. Radiologic imaging demonstrated biliary dilation in three of nine (33 percent) patients studied. Review of serial liver function tests showed no effect of ganciclovir therapy on the course of cholestatic abnormalities. AIDS patients without CMV end-organ disease were also reviewed for evidence of cholestasis. Six of 15 AIDS patients with positive blood culture results for cytomegalovirus had cholestatic liver enzyme abnormalities compared with four of 36 AIDS patients with negative viral blood culture results (p = 0.023, Fisher's exact test). Patients with cytomegalovirus retinitis, gastrointestinal disease, or viremia appear to be at increased risk for the development of cholestasis. In 3 to 11 percent of patients with cytomegalovirus retinitis or gastrointestinal disease, PS/SC may develop. This clinical association supports an etiologic role for cytomegalovirus in the PS/SC syndrome.