Association of Noncirrhotic Portal Hypertension in HIV‐Infected Persons and Antiretroviral Therapy with Didanosine: A Nested Case‐Control Study

Abstract

We found a strong association between prolonged exposure to didanosine and the development of NCPH.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…Noncirrhotic portal hypertension has been reported as a rare complication of exposure to ddI in adults 126, 127, 128 and children 129, 130, may be associated with a genetic predisposition 126 and can become evident after ddI has been discontinued. PENTA does not support the use of d4T or ddI in first‐ or second‐line ART.…”

“…For infants with first‐line failure, ddI may be substituted for TDF; however, recent case reports of noncirrhotic portal hypertension in HIV‐infected adolescents following prolonged exposure to ddI are of concern 126, 127, 128, 129, 130. Therefore, ddI exposure should be kept to a minimum with substitution of an alternative agent at the earliest opportunity.…”

Analysis of the Hepatic Functional Reserve, Portal Hypertension, and Prognosis of Patients With Human Immunodeficiency Virus/Hepatitis C Virus Coinfection Through Contaminated Blood Products in Japan

“…4,5 One of the ART drugs, Didanosin (DDI), has been suspected to under the serious morbidity observed in co-infected patients. 6 Thus, not only in patients with deteriorated liver function, such as in Child-Pugh B or C cases, but also even in Class A cases, the patients' liver function can easily deteriorate abruptly. 7 The natural course of pure NCPH is unknown, because it can be modulated by HCV or other causes, and has only been reported as case series.…”

Noncirrhotic Portal Hypertension and Didanosine: A Re-Analysis

“…Adding prior information can limit this bias by assigning essentially zero prior probability to clinically implausible values of an estimate. One of us (MBK), a clinician with expertise in liver disease and HIV infection, having read other case reports and series (see Table 1 in [1]) and before reading about this study, asserted her opinion that the odds of NCPH in exposed patients, compared to those unexposed, was a ratio of 1.2 per year of exposure to DDI, with a 95% confidence interval (CI) of .5-2.5. We generated a set of matched case-control pairs to represent this prior opinion and then reran the analysis using both prior and real data [7,8].…”

“…To the Editor-In 2020, Kovari et al [1] reported a strong association between exposure to didanosine (DDI) and noncirrhotic portal hypertension (NCPH), a rare condition likely to be of multifactorial etiology. However, the authors were not able to control confounding through multivariate modeling because of the small number of case patients.…”