title: Prevalence of significant liver disease in human immunodeficiency virus-infected patients exposed to Didanosine: A cross sectional study.
abstract: OBJECTIVE
  To identify significant liver disease [including nodular regenerative hyperplasia (NRH)] in asymptomatic Didanosine (DDI) exposed human immunodeficiency virus (HIV) positive patients.
  
  
  METHODS
  Patients without known liver disease and with > 6 mo previous DDI use had liver stiffness assessed by transient elastography (TE). Those with alanine transaminase (ALT) above upper limit normal and/or TE > 7.65 kPa underwent ultrasound scan (U/S). Patients with: (1) abnormal U/S; or (2) elevated ALT plus TE > 7.65 kPa; or (3) TE > 9.4 kPa were offered trans-jugular liver biopsy (TJLB) with hepatic venous pressure gradient (HVPG) assessment.
  
  
  RESULTS
  Ninety-nine patients were recruited, median age 50 years (range 31-70), 81% male and 70% men who have sex with men. Ninety-five percent with VL < 50 copies on antiretroviral therapy with median CD4 count 639 IU/L. Median DDI exposure was 3.4 years (range 0.5-14.6). Eighty-one had a valid TE readings (interquartile range/score ratio < 0.3): 71 (88%) < 7.65 kPa, 6 (7%) 7.65-9.4 kPa and 4 (6%) > 9.4 kPa. Seventeen (17%) met criteria for TJLB, of whom 12 accepted. All had HVPG < 6 mmHg. Commonest histological findings were steatosis (n= 6), normal architecture (n= 4) and NRH (n= 2), giving a prevalence of previously undiagnosed NRH of 2% (95%CI: 0.55%, 7.0%).
  
  
  CONCLUSIONS
  A screening strategy based on TE, liver enzymes and U/S scan found a low prevalence of previously undiagnosed NRH in DDI exposed, asymptomatic HIV positive patients. Patients were more likely to have steatosis highlighting the increased risk of multifactorial liver disease in this population.
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Logan
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Rodger
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Maynard-Smith
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fernandez
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ferro
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.affiliation: Sarah Logan, Alison Rodger, Laura Maynard-Smith, Thomas Fernandez, Filippo Ferro, Sanjay Bhagani, the Ian Charleson Day Centre, Ground Floor, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagani
keywords: Didanosine; Human immunodeficiency virus; Nodular regenerative hyperplasia; Non-cirrhotic portal hypertension; Steatosis