Although liver test abnormalities are frequently identified in patients with 
acquired immunodeficiency syndrome (AIDS), the causes, evaluation, and outcome 
of jaundice in these patients have not been systematically evaluated. From 
August 1, 1990 through September 1, 1994, all human immunodeficiency virus 
(HIV)-infected patients with liver test abnormalities seen by the 
gastroenterology service at a large, inner-city hospital were prospectively 
identified. Jaundice was defined as a serum bilirubin concentration > or = 3 
mg/dL. The etiology of jaundice was determined by the pattern of liver 
biochemistry test abnormalities, radiographic studies, liver biopsy, clinical 
follow-up, and autopsy. During the study period, 541 HIV-infected patients (511 
with AIDS) were evaluated for liver disease by our service; 36 of these patients 
had jaundice (7 percent). The most common causes of jaundice were drug-induced 
hepatitis, occurring in 11 patients (31 percent), and alcoholic liver disease, 
occurring in 5 (13 percent). Opportunistic infections or neoplasms were 
identified as the cause of jaundice in 11 patients (30 percent), with 4 having 
intrahepatic disease and 7 having extrahepatic disease. Multiple potential 
causes were seen in 3 patients. Abdominal ultrasonography (US) and computed 
tomography (CT) were helpful in suggesting the underlying cause of disease. The 
short-term mortality was high, with 9 patients dying during the hospitalization 
(25 percent) and 7 patients dying within 6 months of evaluation. Liver disease 
was the cause of death in 7 of these patients. In conclusion, jaundice is 
uncommon in AIDS and may result from a variety of both opportunistic and 
non-opportunistic etiologies. Drug-induced hepatitis is the most common cause 
and may be fatal. Long-term survival was poor.