TY - JOUR
T1 - Non-cirrhotic portal hypertension in HIV mono-infected patients
AU - Jackson, Belinda D
AU - Doyle, Joseph S
AU - Hoy, Jennifer F
AU - Roberts, Stuart K
AU - Colman, John
AU - Hellard, Margaret E
AU - Sasadeusz, Joseph J
AU - Iser, David M
PY - 2012/9
Y1 - 2012/9
N2 - Background and Aim: Unexplained liver injury including fibrosis and portal hypertension has rarely been reported among patients with HIV in the absence of co-infection with hepatitis B (HBV) or hepatitis C (HCV). We describe a series of HIV mono-infected patients with evidence of non-cirrhotic portal hypertension. Methods: HIV-infected patients with evidence of portal hypertension who were anti-HBV and anti-HCV negative and HBV and HCV RNA polymerase chain reaction (PCR) negative were identified from patients managed by the Victorian statewide HIV referral service located at The Alfred Hospital, Melbourne. Portal hypertension was defined as either radiological or endoscopic evidence of varices, portal vein flow obstruction, or elevated hepatic venous pressure gradient (HPVG). Results: Five patients were found to have portal hypertension. These patients were male, aged 41 to 65years, with known duration of HIV infection between 11 to 25years. All had been treated with antiretroviral therapy, including didanosine. Tests for metabolic, autoimmune, and hereditary causes of liver disease failed to establish an etiology for the liver injury. All had radiological or endoscopic findings of varices, and four patients had radiological features of portal vein obstruction or flow reversal. Only one patient underwent HPVG measurement, which was elevated. Non-invasive fibrosis assessment revealed increased liver stiffness in three (out of four) patients, and no cirrhotic features were found on those who underwent liver biopsy. Conclusions: To our knowledge, this is the largest published series of non-cirrhotic portal hypertension in HIV mono-infected patients in Australia. Further research is needed to understand what relationship, if any, HIV or its treatments might have on liver injury over time.
AB - Background and Aim: Unexplained liver injury including fibrosis and portal hypertension has rarely been reported among patients with HIV in the absence of co-infection with hepatitis B (HBV) or hepatitis C (HCV). We describe a series of HIV mono-infected patients with evidence of non-cirrhotic portal hypertension. Methods: HIV-infected patients with evidence of portal hypertension who were anti-HBV and anti-HCV negative and HBV and HCV RNA polymerase chain reaction (PCR) negative were identified from patients managed by the Victorian statewide HIV referral service located at The Alfred Hospital, Melbourne. Portal hypertension was defined as either radiological or endoscopic evidence of varices, portal vein flow obstruction, or elevated hepatic venous pressure gradient (HPVG). Results: Five patients were found to have portal hypertension. These patients were male, aged 41 to 65years, with known duration of HIV infection between 11 to 25years. All had been treated with antiretroviral therapy, including didanosine. Tests for metabolic, autoimmune, and hereditary causes of liver disease failed to establish an etiology for the liver injury. All had radiological or endoscopic findings of varices, and four patients had radiological features of portal vein obstruction or flow reversal. Only one patient underwent HPVG measurement, which was elevated. Non-invasive fibrosis assessment revealed increased liver stiffness in three (out of four) patients, and no cirrhotic features were found on those who underwent liver biopsy. Conclusions: To our knowledge, this is the largest published series of non-cirrhotic portal hypertension in HIV mono-infected patients in Australia. Further research is needed to understand what relationship, if any, HIV or its treatments might have on liver injury over time.
KW - Anti-retroviral therapy
KW - Human immunodeficiency virus
KW - Liver disease
KW - Portal hypertension
UR - http://www.scopus.com/inward/record.url?scp=84865372266&partnerID=8YFLogxK
U2 - 10.1111/j.1440-1746.2012.07148.x
DO - 10.1111/j.1440-1746.2012.07148.x
M3 - Article
AN - SCOPUS:84865372266
SN - 0815-9319
VL - 27
SP - 1512
EP - 1519
JO - Journal of Gastroenterology and Hepatology
JF - Journal of Gastroenterology and Hepatology
IS - 9
ER -