title: Noncirrhotic Portal Hypertension in Perinatally HIV-infected Adolescents Treated With Didanosine-containing Antiretroviral Regimens in Childhood.
abstract: BACKGROUND
  Noncirrhotic portal hypertension (NCPH) has been reported in HIV-infected adults. Antiretroviral drugs, as well as genetic and thrombophilic predisposition, have been suggested as possible etiologic factors.
  
  
  METHODS
  Clinical data were collected from 6 HIV-infected patients attending the Infectious Diseases Departments at respectively Emma Children's Hospital Academic Medical Centre in Amsterdam, The Thai Red Cross AIDS Research Centre, Bangkok, Imperial College Healthcare NHS Trust, London who were diagnosed with NCPH. All underwent extensive blood analysis, liver ultrasound, liver elastography, esophagogastroduodenoscopy and percutaneous needle liver biopsy for histological evaluation.
  
  
  RESULTS
  We describe 6 perinatally HIV-infected adolescents, all female, who developed NCPH after prolonged exposure during childhood to a didanosine-containing antiretroviral regimen. Histology and electron microscopy showed periportal fibrosis and mitochondrial damage as key findings in their liver biopsies. One of these 6 patients required surgical intervention, the remainder have been managed conservatively to date.
  
  
  CONCLUSIONS
  Thus, symptomatic NCPH may present in adolescence after perinatally acquired HIV-1 infection. In this case series, risk factors included female sex and prolonged exposure to antiretroviral regimens that included the nucleoside-analogue didanosine in childhood.
authors.affiliation: From the *Department of Pediatric Hematology, Immunology and Infectious Diseases, and †Department of Pathology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands; ‡Department of Pathology, MCH-Bronovo Hospital, The Hague, The Netherlands; §Faculty of Medicine, Chulalongkorn University and HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand; ¶U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, & Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, ‖Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of **Radiodiagnostics and ††Infectious Diseases, AMC; and ‡‡Department of Pediatric Gastroenterology, Emma Children's Hospital, AMC, Amsterdam, The Netherlands.
authors.forename: Henriette J
authors.initials: HJ
authors.lastname: Scherpbier
authors.forename: Valeska
authors.initials: V
authors.lastname: Terpstra
authors.forename: Dasja
authors.initials: D
authors.lastname: Pajkrt
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthakanit
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Caroline
authors.initials: C
authors.lastname: Foster
authors.forename: Marius
authors.initials: M
authors.lastname: van den Bergh Weerman
authors.forename: Eline E
authors.initials: EE
authors.lastname: Deurloo
authors.forename: Marc
authors.initials: M
authors.lastname: van der Valk
authors.forename: Taco W
authors.initials: TW
authors.lastname: Kuijpers
authors.forename: Bart G
authors.initials: BG
authors.lastname: Koot
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016049:Didanosine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D006975:Hypertension, Portal; D018445:Infectious Disease Transmission, Vertical; D008099:Liver / Q000473:pathology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D016049:Didanosine