Secondary HIV Cholangiopathy as a Cause of Acute Cholangitis: A Case Report.

HIV-associated cholangiopathy (HAC) is a rare but clinically important hepatobiliary complication occurring in patients with advanced immunosuppression, particularly those with cluster of differentiation 4+ (CD4+) counts below 100 cells/μL. It is most often triggered by opportunistic infections and can present as a spectrum of biliary abnormalities that result in cholestasis and obstruction. We present the case of a 58-year-old man with a history of HIV infection (B24) under regular follow-up, with an undetectable CD4 count and elevated viral load, who presented to the emergency department with jaundice, severe right upper quadrant and epigastric abdominal pain, nausea, vomiting, and a 10 kg weight loss over the past month. During hospitalization, a complex distal common bile duct (CBD) stricture was identified, accompanied by acute cholangitis, obstructive pancreatitis, and acute kidney injury (AKI) on a background of chronic kidney disease (CKD). The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement, resulting in clinical improvement. HIV-associated cholangiopathy was confirmed as the underlying diagnosis. This case highlights the need to consider HAC in immunosuppressed patients presenting with cholestatic liver profiles and supports the importance of timely endoscopic intervention and multidisciplinary management.