didanosine and Gastrointestinal-Hemorrhage

Topics: Adult; Anti-HIV Agents; Biopsy; Chemical and Drug Induced Liver Injury; Didanosine; Endothelium, Vascular; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hematemesis; Hepatomegaly; Humans; Hypertension, Portal; Liver; Liver Function Tests

Non-cirrhotic portal hypertension is an unusual but potentially serious liver disorder in human immunodeficiency virus-infected patients with prolonged exposure to didanosine. Due to its rarity, the diagnosis is often delayed. It is postulated that didanosine contributes to obliterative portal venopathy and causes portal hypertension. Affected patients may present with abnormal liver function or signs of portal hypertension, while the diagnosis usually depends on liver biopsy. We report a case of non-cirrhotic portal hypertension in a human immunodeficiency virus-infected patient. The reported histological features include nodular regenerative hyperplasia and hepatoportal sclerosis. Early recognition is important as timely management of severe portal hypertension may prevent potentially fatal gastro-intestinal bleeding.

Topics: Anti-HIV Agents; Didanosine; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; HIV Infections; Humans; Hypertension, Portal; Male; Middle Aged; Severity of Illness Index; Time Factors

Non-cirrhotic portal hypertension (NCPH) has been associated with didanosine (ddI) exposure. We aimed to determine the number of individuals with NCPH within our cohort and define their characteristics. We identified individuals within our cohort with NCPH and performed a retrospective case note review. Cumulative antiretroviral therapy (ART) use was calculated and a statistical analysis performed to compare exposure to the rest of the clinic cohort for the same time period. Where available, data was collated on FibroScan®, echocardiography and coagulation profile. Seventeen patients were identified. Upper gastrointestinal bleeding was the most common presenting feature. Liver biopsy showed mild portal or periportal fibrosis in 13 (81%) and four with features of nodular regenerative hyperplasia. There was significantly greater exposure to ddl in this group (59.5 months) compared to the rest of the HIV cohort (21.1 months) P = <0.001. Eleven subjects has a liver elastography performed, six (55%) had a result greater than 9.6 kPa (consistent with greater than F2 disease by Metavir scoring). Echocardiography was performed in seven patients: four met criteria for pulmonary hypertension. This is consistent with other cohorts demonstrating an association between the didanosine exposure and NCPH. Our data also suggest an increased risk of pulmonary hypertension.

Topics: Adult; Anti-HIV Agents; Cohort Studies; Didanosine; Female; Gastrointestinal Hemorrhage; HIV Infections; Humans; Hypertension, Portal; Hypertension, Pulmonary; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric

Liver disease of unknown cause in HIV-infected persons is rare but increasingly being reported. Noncirrhotic portal hypertension is the main feature in a subset of these patients, in whom gastrointestinal bleeding is the most frequent and potentially life-threatening clinical presentation.. We describe the epidemiological, clinical and histological features of 12 HIV-positive individuals presenting with noncirrhotic portal hypertension.. An interpretable liver biopsy was available in 11, and cirrhosis was absent in all patients. Three patients had nodular regenerative hyperplasia of the liver, whereas eight showed morphological features previously described as 'hepatoportal sclerosis'. In four of the later group, a distinctive lesion was noted characterized by massive absence of portal veins along with focal fibrous obliteration of small portal veins. All patients had been treated with didanosine for long periods and inflammatory and thrombotic processes hypothetically triggered by this purine analogue in the hepatic microvasculature might result in this form of obliterative portal venopathy.. Noncirrhotic portal hypertension is a rare but unique entity presenting in HIV-positive individuals generally with prior prolonged exposure to didanosine, which shows an obliteration of portal veins as the most distinctive histological finding in the liver.

Topics: Adult; Anti-Retroviral Agents; Didanosine; Female; Gastrointestinal Hemorrhage; HIV Infections; Humans; Hypertension, Portal; Liver Diseases; Male; Middle Aged