title: Noncirrhotic portal hypertension in patients with human immunodeficiency virus-1 infection.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Exposure to didanosine and/or a hypercoagulable tendency might predispose patients infected with HIV-1 to vascular changes resulting in NCPH.
authors.affiliation: Department of Internal Medicine, Atlanta Medical Center, Atlanta, Georgia, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Saifee
authors.forename: Dean
authors.initials: D
authors.lastname: Joelson
authors.forename: James
authors.initials: J
authors.lastname: Braude
authors.forename: Roshan
authors.initials: R
authors.lastname: Shrestha
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
authors.forename: Marty
authors.initials: M
authors.lastname: Sellers
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galambos
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Rubin
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016049:Didanosine / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019851:Thrombophilia; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine; D016049:Didanosine