Original Article

Risk factors and outcome of HIV-associated idiopathic noncirrhotic portal hypertension

  1. J. N. L. Schouten1,
  2. M. E. Van der Ende2,
  3. T. Koëter1,
  4. H. H. M. Rossing1,
  5. M. Komuta3,
  6. J. Verheij4,
  7. M. van der Valk5,
  8. B. E. Hansen1,
  9. H. L. A. Janssen1,*

Article first published online: 13 SEP 2012

DOI: 10.1111/apt.12049

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 36, Issue 9, pages 875–885, November 2012

Additional Information

How to Cite

Schouten, J. N. L., Van der Ende, M. E., Koëter, T., Rossing, H. H. M., Komuta, M., Verheij, J., van der Valk, M., Hansen, B. E. and Janssen, H. L. A. (2012), Risk factors and outcome of HIV-associated idiopathic noncirrhotic portal hypertension. Alimentary Pharmacology & Therapeutics, 36: 875–885. doi: 10.1111/apt.12049

Author Information

  1. 1

    Department of Gastroenterology Hepatology, University Hospital Rotterdam, Rotterdam, the Netherlands

  2. 2

    Department of Infectious diseases, University Hospital Rotterdam, Rotterdam, the Netherlands

  3. 3

    Morphology and Molecular Pathology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium

  4. 4

    Morphology and Molecular Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

  5. 5

    Department of Infectious diseases and Department of Gastroenterology Hepatology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

* Correspondence to:
Prof. H. L. A. Janssen, Department of Gastroenterology Hepatology, Erasmus Medical Center, ‘s Gravendijkwal 230, 3015 GD Rotterdam, the Netherlands.
E-mail: h.janssen@erasmusmc.nl

Publication History

  1. Issue published online: 3 OCT 2012
  2. Article first published online: 13 SEP 2012
  3. Manuscript Accepted: 27 AUG 2012
  4. Manuscript Revised: 24 AUG 2012
  5. Manuscript Revised: 15 AUG 2012
  6. Manuscript Received: 2 AUG 2012

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Summary

Background

Idiopathic noncirrhotic portal hypertension (INCPH) has been reported increasingly in patients with HIV infection.

Aim

To evaluate the number of nationwide diagnosed HIV-associated INCPH cases and to assess its clinical features, risk factors and outcome.

Methods

All HIV centres in the Netherlands were contacted and requested to notify INCPH cases diagnosed in their population. A case–control study was performed to identify the risk factors of INCPH. The cases were group-matched for duration of follow-up after HIV diagnosis to controls. Controls were selected from a database of HIV patients with negative screening for signs of portal hypertension on abdominal ultrasound. Univariate and multivariate conditional logistic regression analyses were performed.

Results

On 1st of July 2011, 18.085 individuals were infected with HIV in the Netherlands. Within this population, sixteen patients with clinically overt INCPH were identified. At the time of INCPH diagnosis, cases had a lower platelet count and a higher ALT level. In univariate and multivariate analyses, didanosine [OR: 1.9 (1.3–2.8)], concomitant didanosine and stavudine treatment [OR: 6.3 (2.1–19.1)] and concomitant didanosine and tenofovir treatment [OR: 5.1 (1.2–22.6)] were independently associated INCPH. During follow-up, 4 patients died [malignancy (n = 3), liver failure (n = 1)]. A significant decline in platelets was observed after didanosine discontinuation (P = 0.003).

Conclusions

HIV-associated clinically relevant idiopathic noncirrhotic portal hypertension appears to be a rarely diagnosed disease. Long-term exposure to didanosine and short-term combination of didanosine and stavudine or tenofovir exposure are associated with idiopathic noncirrhotic portal hypertension. Mortality in HIV-associated idiopathic noncirrhotic portal hypertension is mainly related to HIV-associated disorders. Portal hypertension continues despite didanosine discontinuation.

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