Noncirrhotic portal hypertension in patients with human immunodeficiency virus-1 infection.
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.
Saifee
Sophia
S
Department of Internal Medicine, Atlanta Medical Center, Atlanta, Georgia, USA.
Joelson
Dean
D
Braude
James
J
Shrestha
Roshan
R
Johnson
Mark
M
Sellers
Marty
M
Galambos
Michael R
MR
Rubin
Raymond A
RA
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
D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine; D016049:Didanosine