{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:57:19Z","timestamp":1791219439513,"version":"4.1.0"},"reference-count":19,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,17]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>We report a woman in her 50s who presented with jaundice and severe hepatocellular injury, concurrently found to have newly diagnosed advanced HIV infection (CD4 count 17, viral load 195\u2009600 copies\/mL). In this context, infectious hepatitis or opportunistic infections were the important initial consideration, but viral serology, imaging and liver biopsy excluded opportunistic and viral causes. Markedly raised immunoglobulin G, positive anti-nuclear and smooth muscle antibodies, typical histology and rapid response to corticosteroids confirmed acute autoimmune hepatitis (AIH). She improved on prednisolone, transitioned to azathioprine and commenced antiretroviral therapy with subsequent normalisation of liver function and undetectable HIV viral load. De novo AIH presenting concurrently with advanced HIV and profound immunosuppression is exceptionally rare, with few reported cases in the literature. It highlights that, even in this paradoxical setting, diligent investigation can uncover rare but treatable causes of liver dysfunction.<\/jats:p>","DOI":"10.1136\/bcr-2026-274255","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:10:21Z","timestamp":1791216621000},"page":"e274255","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute autoimmune hepatitis diagnosed concurrently with human immunodeficiency virus"],"prefix":"10.1136","volume":"19","author":[{"given":"George","family":"Lennox","sequence":"first","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abed","family":"Arnaout","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hamzah","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjuna","family":"Singanayagam","sequence":"additional","affiliation":[{"name":"Infection Clinical Academic Group, City St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100509101389000_19.10.e274255.1","unstructured":"National AIDS Trust . UK HIV statistics. Available: https:\/\/nat.org.uk\/about-hiv\/hiv-statistics\/ [Accessed 11 Sep 2025]."},{"key":"2026100509101389000_19.10.e274255.2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14746"},{"key":"2026100509101389000_19.10.e274255.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-070201","article-title":"Diagnosis and management of autoimmune hepatitis","volume":"380","author":"Muratori","year":"2023","journal-title":"BMJ"},{"key":"2026100509101389000_19.10.e274255.4","doi-asserted-by":"crossref","first-page":"100149","DOI":"10.1016\/j.jhepr.2020.100149","article-title":"Approach to the patient with acute severe autoimmune hepatitis","volume":"2","author":"Rahim","year":"2020","journal-title":"JHEP Reports"},{"key":"2026100509101389000_19.10.e274255.5","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00296-016-3555-7","article-title":"Kaleidoscope of autoimmune diseases in HIV infection","volume":"36","author":"Roszkiewicz","year":"2016","journal-title":"Rheumatol Int"},{"key":"2026100509101389000_19.10.e274255.6","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1086\/524082","article-title":"De Novo Autoimmune Hepatitis during Immune Reconstitution in an HIV-Infected Patient Receiving Highly Active Antiretroviral Therapy","volume":"46","author":"O\u2019Leary","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2026100509101389000_19.10.e274255.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcg.0000225591.08825.3e"},{"key":"2026100509101389000_19.10.e274255.8","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2009.009337"},{"key":"2026100509101389000_19.10.e274255.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000006011","article-title":"Autoimmune hepatitis in patients with human immunodeficiency virus (HIV): Case reports of a rare, but important diagnosis with therapeutic implications","volume":"96","author":"Kia","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2026100509101389000_19.10.e274255.10","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.4254\/wjh.v9.i36.1367","article-title":"Autoimmune hepatitis in the setting of human immunodeficiency virus infection: A case series","volume":"9","author":"Ofori","year":"2017","journal-title":"World J Hepatol"},{"key":"2026100509101389000_19.10.e274255.11","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7348168"},{"key":"2026100509101389000_19.10.e274255.12","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000017094","article-title":"Autoimmune hepatitis in patients with human immunodeficiency virus infection: A systematic review of the published literature","volume":"98","author":"Mubder","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2026100509101389000_19.10.e274255.13","doi-asserted-by":"crossref","first-page":"5388","DOI":"10.3748\/wjg.v25.i35.5388","article-title":"Autoimmune hepatitis in human immunodeficiency virus-infected patients: A case series and review of the literature","volume":"25","author":"Chaiteerakij","year":"2019","journal-title":"World J Gastroenterol"},{"key":"2026100509101389000_19.10.e274255.14","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.jceh.2022.05.003","article-title":"AIH in HIV: A Very Much Possible Entity","volume":"12","author":"Lad","year":"2022","journal-title":"J Clin Exp Hepatol"},{"key":"2026100509101389000_19.10.e274255.15","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000005769","article-title":"Autoimmune diseases and HIV infection","volume":"96","author":"Virot","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2026100509101389000_19.10.e274255.16","first-page":"93","article-title":"The demographics of autoimmune hepatitis in human immunodeficiency virus-infected patients: a United States cross-sectional study","volume":"18","author":"Saleem","year":"2023","journal-title":"Prz Gastroenterol"},{"key":"2026100509101389000_19.10.e274255.17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4103\/ijstd.ijstd_73_22","article-title":"Coexistence of human immunodeficiency virus infection and autoimmune hepatitis: A double trouble","volume":"44","author":"Manrai","year":"2023","journal-title":"Indian J Sex Transm Dis AIDS"},{"key":"2026100509101389000_19.10.e274255.18","doi-asserted-by":"crossref","first-page":"42298428","DOI":"10.1186\/s12879-026-13311-9","article-title":"The clinical features, pathological assessment, and prognostic analysis of autoimmune hepatitis in Chinese persons living with HIV","volume":"26","author":"Wang","year":"2026","journal-title":"BMC Infect Dis"},{"key":"2026100509101389000_19.10.e274255.19","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000527337","article-title":"Autoimmune Liver Disease in Human Immunodeficiency Virus-Infected Patients: 3 Case Series","volume":"30","author":"Rafael","year":"2023","journal-title":"GE Port J Gastroenterol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274255","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:10:24Z","timestamp":1791216624000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":19,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-274255"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274255","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}