Noncirrhotic portal hypertension in patients with human immunodeficiency virus-1 infection

Noncirrhotic portal hypertension (NCPH) is unusual in North American patients. This study characterized patients with NCPH and human immunodeficiency virus-1 (HIV-1) infection to identify potential risk factors for this association.

Eleven consecutive patients from our urban hepatology clinic with HIV-1 infection and NCPH were the subject of this series. Case histories, including medication lists and laboratory data, were analyzed.

Age at diagnosis was 51 +/- 7 years. CD4 count was 303 +/- 185 cells/mL, and HIV viral load was <75 copies/mL in 9 patients. Didanosine was the only medication taken by all patients; 10 each had taken lamivudine and zidovudine. In the 10 patients tested, 8 had at least 1 thrombophilic abnormality; 6 were deficient in protein S, and 2 had multiple abnormalities. Nodular regenerative hyperplasia was observed in all 11 and portal venulopathy in 5 patients. All patients had esophageal varices; 3 developed variceal bleeding. Six patients had ascites; 2 required transjugular intrahepatic portal systemic shunt.

Exposure to didanosine and/or a hypercoagulable tendency might predispose patients infected with HIV-1 to vascular changes resulting in NCPH.