Liver: HIV and drug-induced cholestasis

Drug-induced cholestasis This is a high power microscopic view of a section of liver from an adult with intrahepatic cholestasis and HIV infection. The patient was on fluconazole treatment (an anti-fungal agent) and presented with jaundice. The liver cells are swollen and pale, and some have double nuclei. The brownish pigment in, and between, the cells is bile (cholestasis). H&E stain. Many of the drugs used in HIV disease are hepatotoxic. These include antiretroviral drugs (which can cause severe steatosis), and drugs used to treat opportunistic infections (eg. rifampicin and antifungal agents).