Noncirrhotic portal hypertension in HIV infection

Abstract

NCPH is an uncommon condition, although increasingly being reported in HIV-infected individuals. It generally presents as a clinical episode of decompensated portal hypertension, generally with gastrointestinal bleeding. Long-lasting HIV infection and prolonged antiretroviral exposure are universally recognized in these patients. The involvement of didanosine has been highlighted in most series. Removal of this drug and prevention of variceal bleeding episodes are currently the most effective prophylactic and therapeutic interventions.

HBV and HIV co-infection: Impact on liver pathobiology and therapeutic approaches

“…The consequences of HIV monoinfection is also linked to liver portal obliteration with nodular regenerative hyperplasia, responsible for noncirrhotic portal hypertension [20,21] . In adult-acquired HBV infected individuals, the secondary infection with HIV leads to the chances of developing chronic hepatitis B by six-fold compared to HBV mono-infected patients [22,23] .…”

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

“…In part because of its associated hepatotoxicity, the use of DDI has declined substantially and it is now regarded as a lower-tier anti-retroviral medication [12] . Although it is clear that DDI-induced NRH does persist for years after cessation of the medication; interruption has still been associated with an overall better prognosis [27][28][29] . Treatment of the clinical manifestations of NRH revolves around the primary prophylaxis of esophageal variceal bleeding in asymptomatic patients.…”

“…Arey et al [21] Case report 1 Abdominal distention, abdominal, pain, EV Bihl et al [31] Case report 1 Abdominal pain, ALP, ascites, EV, GIB, splenomegaly Bissonnette et al [11] Case report 2 Ascites, EV, GIB Cachay et al [15] Case series 1 ALP Saifee et al [52] Case series 11 Ascites, EV, GIB Cesari et al [53] Case control 5 Ascites, EV, GIB, splenomegaly Cotte et al [12] Case control 13 Abdominal pain, ALP, ascites, EV, GIB, splenomegaly Alvarez Díaz et al [33] Case report 2 ALP, ascites, EV, GIB Ding et al [54] Case report 1 ALP, EV, GIB, ascites Dinh et al [55] Case control 3 Ascites, encephalopathy, EV Fernandez-Miranda et al [9] Case report 1 Unknown Garvey et al [19] Case report 2 EV, splenomegaly Hofmaenner et al [27] Case report 1 Epigastric pain, ALP Kochin et al [56] Case report 1 EV, GIB Kovari et al [23] Case control 1 EV Maida et al [8] Case series 2 Splenomegaly Mallet et al [4] Case control 13 ALP, EV, GIB Mallet et al [57] Case report 1 Portal hypertension Mallet et al [30] Case series 8 ALP, ascites, EV, splenomegaly Mendizabal et al [58] Case control 5 EV, GIB Podevin et al [59] Case report 1 Ascites, EV, splenomegaly Sandrine et al [20] Case report 1 ALP, ascites, EV, splenomegaly Santiago et al [28] Case report 1 Abdominal distention, splenomegaly Schiano et al [22] Case report 1 ALP, EV, splenomegaly Scourfield et al [60] Retrospective cohort 4 Unknown Schouten et al [61] Case report 3 EV, GIB Stebbing et al [62] Retrospective cohort 2 ALP Tateo et al [13] Case report 3 ALP, ascites, EV, GIB Vispo et al [29] Case report 3 ALP, ascites, EV, GIB ALP: Abnormal liver panel; EV: Esophageal varices; GIB: Gastrointestinal bleed. hypersplenism (Table 1).…”

Noncirrhotic Portal Hypertension in Perinatally HIV-infected Adolescents Treated With Didanosine-containing Antiretroviral Regimens in Childhood

“…11,15 The etiology of NCPH is not fully understood but is most likely multifactorial. 10,11,15,16 A correlation with the use of nucleoside analogues, particularly with didanosine [17][18][19] , has been suggested. Subsequently in January 2010 the labeling regulations for didanosine were updated by the Food and Drug Administration to include information on NCPH (www.accessdata.fda.gov/drugsatfda_docs/label/2010/020156s046lbl.pdf).…”

“…[4][5][6][7][8] In addition to hepatotropic viruses and HIV itself, microbial translocation from the gut to the portal tract may contribute to liver disease in HIV-infected patients. 5,9 Symptomatic noncirrhotic portal hypertension (NCPH), defined as the presence of portal hypertension in the absence of cirrhotic change 15 has to date been reported in around 140 HIVinfected adults and 2 HIV-infected children. [10][11][12][13][14] Early diagnosis is necessary to reduce the emergence of severe complication, such as variceal bleeding, portal thrombosis and ascites in relation to portal hypertension.…”