Abstract
Non-cirrhotic portal hypertension (NCPH) has been recently reported as a liver disease in Human Immunodeficiency Virus (HIV)-infected patients under antiretroviral therapy (ART). Combination of non-exclusive mechanisms has been described: primary endothelial damage of terminal portal veins induced by HIV or immunologic disorders, mitochondrial toxicity by didanosine and prothrombotic state. It is characterized by heterogeneous liver histological findings, frequently identified as nodular regenerative hyperplasia and clinical manifestations of portal hypertension with well-preserved liver function. We describe herein two HIV-infected patients with clinical picture suggestive of NCPH. Besides the case reports, we briefly address questions to apply to patient care in clinical practice.
Highlights
Non-cirrhotic portal hypertension (NCPH) is an emerging clinical condition reported in Human Immunodeficiency Virus (HIV)- infected patients controlled with antiretroviral therapy (ART), consisting of intrahepatic portal hypertension, in the absence of cirrhosis and other known etiologies of liver disease
No liver enzyme elevations were noted before initiating ART and progressive cholestasis appeared after it (ART scheme including didanosine)
Hypercoagulable state was not evaluated in first case, but protein C and S low levels were found in second patient
Summary
Non-Cirrhotic Portal Hypertension in Human Immunodeficiency VirusInfected Patients: A New Challenge in Antiretroviral Therapy Era. Infectious Diseases Unit, Department of Internal Medicine, Hospital Arquitecto Marcide-Profesor Novoa Santos, Ferrol, A Coruña, Spain
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