Background/introduction Liver disease is an important cause of morbidity and mortality in patients infected with HIV infection. Abnormal liver function tests are frequently encountered in these patients and often attributed to HAART. Autoimmune Hepatitis is a rare disease with unclear pathogenesis; several viruses have been proposed to act as triggering agents for the inflammatory process of the disease.

Case presentation We present a 46 year old afro Caribbean gentleman who presented with lethargy, weight loss and jaundice. He was diagnosed to be co-infected with HIV and Hepatitis B with a positive autoimmune screen. His persistently elevated liver enzymes warranted a liver biopsy which revealed interface hepatitis, necrosis with lymphocytes and plasma cell infiltrates with variable degree of fibrosis. A picture difficult to interpret in the light of HIV and Hepatitis B infections. His persistently high ALT made it challenging to initiate antiretroviral therapy and the need for steroids to suppress the autoimmune Hepatitis raised a concern regarding the reactivation of the latent TB infection as diagnosed by a positive IGRA test. A review of literature revealed 12 cases of HIV with AIH, but none co-infected with Hepatitis B.

Conclusion There are no clear guidelines for management of autoimmune Hepatitis in HIV and treatment is with immunosuppressive agents. A multidisciplinary approach helped in the management of this gentlemen who now stable on antiretroviral therapy and tapering doses of steroids, along with chemoprophylaxis against latent TB.