Publications & Reports

Non-cirrhotic portal hypertension in HIV mono-infected patients.

Jackson BD, Doyle JS, Hoy JF, Roberts SK, Colman J, Hellard ME, Sasadeusz JJ, Iser DM
Department of Gastroenterology, The Alfred Hospital Infectious Diseases Unit, The Alfred Hospital, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Centre for Population Health, Burnet Institute, Department of Gastroenterology, St Vincent'

Abstract

Background and Aims: 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 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, 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 3 (out of 4) 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.

Publication

  • Journal: Journal of Gastroenterology and Hepatology
  • Published: 13/04/2012
  • Volume: 27
  • Issue: 9
  • Pagination: 1512-1519

Author

Health Issue