An HIV-infected patient may develop noncirrhotic portal hypertension following long-term antiretroviral therapy. Kovari et al were able to find an association between prolonged exposure to didanosine and this disorder. The authors are from the Swiss HIV Cohort Study.


Criteria for the diagnosis of noncirrhotic portal hypertension:

(1) one or both of the following:

(1a) presence of endoscopically documented esophageal varices

(1b) hepatic venous pressure gradient >= 10 mm Hg

(2) absence of cirrhosis on liver biopsy

(3) exclusion of underlying liver disease associated with cirrhosis (hepatitis C, hepatitis B, alcoholic liver disease, Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency, autoimmune hepatitis, nonalcoholic steatohepatitis, drug-induced hepatitis, etc)


The underlying process appears to be an obstructive portal venopathy, with many patients showing a periportal fibrosis.


Chronic exposure to didanosine (DDI) is a risk factor for HIV-infected patients. Early diagnosis with discontinuation of DDI can be lifesaving.


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