title: Non-cirrhotic portal hypertension in HIV mono-infected patients.
abstract: OBJECTIVE
  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 65 years, with known duration of HIV infection between 11 to 25 years. 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.
authors.affiliation: Department of Gastroenterology, The Alfred Hospital Infectious Diseases Unit, The Alfred Hospital, Australia.
authors.forename: Belinda D
authors.initials: BD
authors.lastname: Jackson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
authors.forename: John
authors.initials: J
authors.lastname: Colman
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Sasadeusz
authors.forename: David M
authors.initials: DM
authors.lastname: Iser
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D044966:Anti-Retroviral Agents