Cryptogenic Pseudocirrhosis: A New Clinical Syndrome of Noncirrhotic Portal Hypertension (Unassociated With Advanced Fibrosis) That Can Be Detected by Transient Elastography in Patients With HIV

Panos, George; Farouk, Lavanta; Stebbing, Justin; Holmes, P; Valero, Sara; Randell, Paul; Bower, Mark; Gazzard, Brian; Anderson, Mike; Nelson, Mark

doi:10.1097/qai.0b013e3181bb27b1

Cited by 10 publications

(8 citation statements)

References 7 publications

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“…Nine of the 17 authors who have published data concerning the histological features of HIV-related NCPH analysed liver specimens using reticulin staining, 10,14,15,22,[24][25][26]28,29 and it is interesting to note that they diagnosed 41 cases of NRH in 55 liver biopsies (74.5%) as against 5/44 (11.3%) in the case of the authors who did not report using reticulin staining. [11][12][13][16][17][18]23,27 Unlike in the general population, in which histology in the presence of advanced cryptogenic liver disease is generally consistent with cirrhosis (usually following non-alcoholic steatohepatitis), 14,38 NRH is the most frequent feature in HIV-infected subjects, and cirrhosis is seldom found. 14 The role of transient elastography (TE) in diagnosing NCPH in HIV-infected patients has been investigated by only a few studies 11,19,24,29 and with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…9-29 Idiopathic NCPH is a rare condition of unknown origin that is characterized by obstructive portal venopathy. 33,36,37 Morphologically, portal and/or central vein abnormalities are frequently observed, and lead to changes in liver architecture consisting of fibrosis and/or atrophic regions with nodules, 33 but histological findings include periportal and perisinusoidal fibrosis, 11,18,23 hepatoportal sclerosis, 17,27 and nodular regenerative hyperplasia (NRH). 22,25 Among the 99 HIVpositive patients with symptomatic NCPH whose biopsy results have been published, the most frequent histological findings have been NRH, followed by hepatoportal sclerosis, microvesicular steatosis, unspecific liver fibrosis and periportal fibrosis (Table 3).…”

Section: Discussionmentioning

confidence: 99%

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Noncirrhotic Portal Hypertension in HIV-Infected Patients: A Case Control Evaluation and Review of the Literature

Cesari

Schiavini

Marchetti

et al. 2010

AIDS Patient Care and STDs

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Idiopathic noncirrhotic portal hypertension (NCPH) is an infrequent but possibly underestimated cryptogenetic liver disease recently described in small series of HIV-infected patients. The exposure to antiretroviral drugs, a direct role of HIV itself, microbial translocation from the gut, or a thrombophilic propensity have been suggested as possible pathogenic mechanisms. In this case control study, we describe 11 HIV-infected patients with idiopathic NCPH and compare the activity of protein C and S, and soluble CD14 levels (a surrogate marker of the translocation of intestinal bacterial products) with 10 age- and gender-matched HIV-infected controls with no liver disease. The clinical presentation of the 11 patients with NCPH was characterised by acute variceal bleeding (2/11), ascites (2/11), portal thrombosis (2/11), and ultrasonographic and endoscopic signs of portal hypertension (11/11), with slightly high alanine transaminase (ALT) and γglutamyl transpeptidase (γ-GT) levels. The FibroScan median liver stiffness was 8.1 kPa, which is inconsistent with significant fibrosis, and nodular regenerative hyperplasia was diagnosed in the 5 patients who underwent liver biopsy. The NCPH patients showed no impairment of hepatic synthesis, but had lower serum albumin levels and a higher international normalized ratio (INR) than the controls (p = 0.01), and lower protein C and S activity, although within the normal range (p = 0.02 and 0.3, respectively). No significant difference in soluble CD14 was seen between the two groups. In conclusion, the etiology of NCHP is not still established, but in order to prevent the dramatic complications of portal hypertension, all HIV-infected patients with unexplained liver enzyme abnormalities or thrombocytopenia should be considered for further investigations by means of thrombophilic screening, Doppler ultrasound evaluation, and in the presence of portal hypertension, endoscopy and liver biopsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Noncirrhotic Portal Hypertension in HIV-Infected Patients: A Case Control Evaluation and Review of the Literature

Cesari

Schiavini

Marchetti

et al. 2010

AIDS Patient Care and STDs

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“…Few studies have focused on HIV–HBV coinfection [47], although TE in HIV–HCV coinfection has been reported [48,49] and a number of recent studies on patients with HBV monoinfection have been published [50–55]. In addition, a number of studies using TE in HIV monoinfected patients have described a small number of patients who have elevated liver stiffness and portal hypertension, with or without typical cirrhotic changes upon liver biopsy [56,57]. In some cases, this may be due to prolonged exposure to didanosine or nonalcoholic steatohepatitis [58].…”

Section: Assessment Of Hbv In Hiv-infected Individualsmentioning

confidence: 99%

Future Directions in the Treatment of Hiv–Hbv Coinfection

Iser

Lewin

2009

HIV Ther.

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Liver disease is a major cause of mortality in individuals with HIV–HBV coinfection. The pathogenesis of liver disease in this setting is unknown, but is likely to involve drug toxicity, infection of hepatic cells with both HIV and HBV, and an altered immune response to HBV. The availability of therapeutic agents that target both HIV and HBV replication enable dual viral suppression, and assessment of chronic hepatitis B is important prior to commencement of antiretroviral therapy. Greater importance is now placed on HBV DNA levels and staging of liver fibrosis, either by liver biopsy or noninvasive measurement, such as transient elastography, since significant liver fibrosis may exist in the presence of normal liver function tests. Earlier treatment of both HIV and HBV is now generally advocated and treatment is usually lifelong.

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“…Recently, there have been increasing reports of liver disease in HIV-infected individuals in the absence of viral hepatitis [7–11]. These diseases largely include liver decompensation with and without evidence of cirrhosis, nonalcoholic liver disease (NALD) its more severe form nonalcoholic steatohepatitis (NASH) and hepatocellular cancer (HCC) [7–11].…”

Section: Introductionmentioning

confidence: 99%

“…These diseases largely include liver decompensation with and without evidence of cirrhosis, nonalcoholic liver disease (NALD) its more severe form nonalcoholic steatohepatitis (NASH) and hepatocellular cancer (HCC) [7–11]. Liver disease in HIV monoinfection has been significantly associated with high HIV RNA, prolonged exposure to cART as well as high body mass index (BMI), alcohol abuse and increasing age [12–14].…”

Section: Introductionmentioning

confidence: 99%

HIV Infection and TLR Signalling in the Liver

Crane

Visvanathan

Lewin

2012

Gastroenterology Research and Practice

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Despite the availability of effective combination antiretroviral therapy (cART), liver disease is one of the leading causes of morbidity and mortality in Human Immunodeficiency Virus (HIV)-infected individuals, specifically, in the presence of viral hepatitis coinfection. HIV, a single stranded RNA virus, can bind to and activate both Toll-like receptor (TLR)7 and TLR8 in circulating blood mononuclear cells, but little is known about the effect of HIV on TLRs expressed in the liver. HIV can directly infect cells of the liver and HIV-mediated depletion of CD4+ T-cells in the gastrointestinal tract (GI tract) results in increased circulating lipopolysaccharide (LPS), both of which may impact on TLR signaling in the liver and subsequent liver disease progression. The potential direct and indirect effects of HIV on TLR signaling in the liver will be explored in this paper.

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Cryptogenic Pseudocirrhosis: A New Clinical Syndrome of Noncirrhotic Portal Hypertension (Unassociated With Advanced Fibrosis) That Can Be Detected by Transient Elastography in Patients With HIV

Cited by 10 publications

References 7 publications

Noncirrhotic Portal Hypertension in HIV-Infected Patients: A Case Control Evaluation and Review of the Literature

Noncirrhotic Portal Hypertension in HIV-Infected Patients: A Case Control Evaluation and Review of the Literature

Future Directions in the Treatment of Hiv–Hbv Coinfection

HIV Infection and TLR Signalling in the Liver

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