Noncirrhotic Portal Hypertension in Patients With Human Immunodeficiency Virus–1 Infection

• Published in: Clinical gastroenterology and hepatology Vol. 6; no. 10; pp. 1167 - 1169
• Main Authors: Saifee, Sophia, Joelson, Dean, Braude, James, Shrestha, Roshan, Johnson, Mark, Sellers, Marty, Galambos, Michael R., Rubin, Raymond A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2008
• Subjects: Adult; Anti-HIV Agents - therapeutic use; CD4 Lymphocyte Count; Didanosine - therapeutic use; Female; Gastroenterology and Hepatology; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; HIV-1 - isolation & purification; Humans; Hypertension, Portal - etiology; Lamivudine - therapeutic use; Male; Middle Aged; Risk Factors; Thrombophilia; Viral Load; Zidovudine - therapeutic use; HIV-1; NCPH; TIPSS; NRH; HAART; noncirrhotic portal hypertension; transjugular intrahepatic portal systemic shunt; highly active antiretroviral therapy; nodular regenerative hyperplasia; human immunodeficiency virus–1
• DOI: 10.1016/j.cgh.2008.04.023
• ISSN: 1542-3565; 1542-7714

Noncirrhotic portal hypertension (NCPH) is unusual in North American patients. This study characterized patients with NCPH and human immunodeficiency virus–1 (HIV-1) infection to identify potential risk factors for this association. Eleven consecutive patients from our urban hepatology clinic with HIV-1 infection and NCPH were the subject of this series. Case histories, including medication lists and laboratory data, were analyzed. Age at diagnosis was 51 ± 7 years. CD4 count was 303 ± 185 cells/mL, and HIV viral load was <75 copies/mL in 9 patients. Didanosine was the only medication taken by all patients; 10 each had taken lamivudine and zidovudine. In the 10 patients tested, 8 had at least 1 thrombophilic abnormality; 6 were deficient in protein S, and 2 had multiple abnormalities. Nodular regenerative hyperplasia was observed in all 11 and portal venulopathy in 5 patients. All patients had esophageal varices; 3 developed variceal bleeding. Six patients had ascites; 2 required transjugular intrahepatic portal systemic shunt. Exposure to didanosine and/or a hypercoagulable tendency might predispose patients infected with HIV-1 to vascular changes resulting in NCPH.