15th Annual Conference of the British HIV Association 1-3 April 2009, Liverpool, UK

NON-CIRRHOTIC PORTAL HYPERTENSION IN HIV-MONO-INFECTED INDIVIDUALS

HIV Med 2009 Apr 1-3 (Suppl 1);15:13 (abstract no. O28)

A Scourfield, LJ Waters, P Holmes, G Panos, K Armenis, J Underwood and M Nelson
Chelsea and Westminster Hospital, London, UK

BACKGROUND: Non-cirrhotic portal hypertension is increasingly recognized in HIV infected individuals. Suggested mechanisms include didanosine (ddI) exposure and chronic HIV-related inflammation.

METHODS: We identified all patients in our cohort with non-cirrhotic portal hypertension and used our prospectively collected database and retrospective notes review to describe background characteristics including antiretroviral exposure. Patients with other hepatic pathology, including viral hepatitides, were excluded.

RESULTS: Fifteen patients (10 male) were identified with a median age of 44 (range 39–50). Mean time from HIV diagnosis to liver decompensation was 11.1 years. Fourteen (93%) individuals had undetectable HIV-RNA at presentation and mean ALT was 83. Nine (60%) individuals presented with upper gastrointestinal bleeding, 12/15 (80%) had varices at endoscopy, six (33%) had ascites and one (7%) had encephalopathy. Eleven (73%) patients had features of portal hypertension on ultrasound. Liver biopsy was performed in all patients; 13 (87%) showed evidence of mild portal or periportal fibrosis (<F2 disease) and 2 (13%) demonstrated features of nodular regenerative hyperplasia. Ten subjects had fibroscan performed and 7 (70%) had scores consistent with >F2 disease. Didanosine accounted for the greatest proportion of cumulative NRTI exposure (20%). Thirteen individuals were on a ddI-containing regimen at diagnosis and two had second fibroscans after ddI discontinuation showing marked improvement. Two individuals also met criteria for pulmonary hypertension on echocardiography.

CONCLUSIONS: Non-cirrhotic portal hypertension should be considered in individuals with chronic HIV infection, longstanding ddI therapy, persistently raised ALT or clinical features of portal hypertension. Fibroscan is a useful non-invasive method for the diagnosis and monitoring of these patients.

2009-04-01
O28

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