title: Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review.
abstract: OBJECTIVE
  To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (HIV).
  
  
  METHODS
  We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: "nodular regenerative hyperplasia", "human immunodeficiency virus", "noncirrhotic portal hypertension", "idiopathic portal hypertension", "cryptogenic liver disease", "highly active antiretroviral therapy" and "didanosine". The bibliographies of these studies were subsequently searched for any additional relevant publications.
  
  
  RESULTS
  The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension - namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH.
  
  
  CONCLUSIONS
  The appropriate management of HIV-infected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.
authors.affiliation: Archita Sood, Department of Medicine, Olive View Medical Center, Sylmar, CA 91342, United States.
authors.forename: Archita
authors.initials: A
authors.lastname: Sood
authors.affiliation: Archita Sood, Department of Medicine, Olive View Medical Center, Sylmar, CA 91342, United States.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castrejón
authors.affiliation: Archita Sood, Department of Medicine, Olive View Medical Center, Sylmar, CA 91342, United States.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
keywords: Ascites; Human immunodeficiency virus; Liver complications; Nodular regenerative hyperplasia; Systematic review