title: Idiopathic portal hypertension in patients with HIV infection treated with highly active antiretroviral therapy.
abstract: OBJECTIVE
  Idiopathic portal hypertension (IPH) is the presence of PH in the absence of liver disease. Recently, IPH was reported in HIV patients on highly active antiretroviral therapy (HAART). We describe for the first time the hepatic and systemic hemodynamic profile, liver stiffness, and histological features of eight patients with HIV-related IPH.
  
  
  METHODS
  HIV-positive patients were identified from our IPH database over 3 years.
  
  
  RESULTS
  Five patients presented with variceal bleeding, two with splenomegaly, and one with ascites. All had large esophageal varices. Median hepatic venous pressure gradient (HVPG) was 8 mm Hg (range 3.5-14.5), clearly underestimating the true portal pressure. This is probably because of a presinusoidal component of PH and because of the presence of intrahepatic venous collaterals. Median liver stiffness was 8.9 kPa (range 6.8-14.9) and was unreliable in predicting the presence of fibrosis or of esophageal varices. The main histological features were absence of portal vein radicles and areas of regenerating hepatocytes. Six patients (75%) developed portal vein thrombosis during a 2-year follow-up.
  
  
  CONCLUSIONS
  There is a subset of HIV patients without cirrhosis but with PH compatible with IPH. In these patients, the hepatic and systemic hemodynamic profile is similar to other forms of IPH. The histological profile reflects an underlying vascular disorder affecting the medium-sized portal vein branches. Development of portal vein thrombosis is a frequent complication and requires close monitoring.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
authors.forename: Pik-Eu
authors.initials: PE
authors.lastname: Chang
authors.forename: Rosa
authors.initials: R
authors.lastname: Miquel
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Blanco
authors.forename: Montserrat
authors.initials: M
authors.lastname: Laguno
authors.forename: Miguel
authors.initials: M
authors.lastname: Bruguera
authors.forename: Juan-G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D001774:Blood Chemical Analysis; D016001:Confidence Intervals; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D007150:Immunohistochemistry; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013997:Time Factors