Risk factors and outcome of <scp>HIV</scp>‐associated idiopathic noncirrhotic portal hypertension

Schouten, Jeoffrey N.L.; Ende, Marchina E. van der; Köeter, Tijmen; Rossing, Henrik Holm; Komuta, Mina; Verheij, Joanne; Valk, Marc van der; Hansen, Bettina E.; Janssen, Harry L.A.

doi:10.1111/apt.12049

Cited by 55 publications

(76 citation statements)

References 29 publications

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“…Finally, a total of 69 well-characterized patients with IPH were included. Mean duration of follow-up from diagnosis was 6.7 6 4.6 years (median, 6; range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

“…In those with symptoms, confirming previous observations, VB was the most common initial manifestation. 1,5,13 The lack of specific symptoms or laboratory abnormalities may defer the diagnosis of IPH. Indeed, 7% of our patients were previously misdiagnosed with cryptogenic cirrhosis and the diagnosis was delayed for more than 1 year in 25%, confirming that IPH diagnosis is demanding and requires a high index of suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…Immunological disorders, recurrent infections, trace metals, medications, and prothrombotic factors have been considered causal features. [3][4][5] Recently, several studies have reported on the association between human immunodeficiency virus (HIV) infection treated with antiretroviral therapy and development of IPH. 3 Patients with IPH usually present with signs and symptoms of portal hypertension (PH), such as splenomegaly, thrombocytopenia, and variceal bleeding (VB).…”

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confidence: 99%

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Idiopathic portal hypertension: Natural history and long-term outcome

et al. 2014

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Idiopathic portal hypertension (IPH) is a rare cause of intrahepatic portal hypertension. Data on natural history and prognosis of IPH are limited. We sought to describe the complications and long-tem outcome of IPH by retrospectively studying 69 biopsyproven cases of IPH. Mean duration of follow-up was 6.7 6 4.6 years. All patients had evidence of portal hypertension (PH) at diagnosis, and 42% were symptomatic. Variceal bleeding (VB) was the most common manifestation. In those without bleeding at diagnosis, 74% had varices at first endoscopy. In those with large varices, the 1-year probability of first bleeding despite primary prophylaxis was 9%. The 1-year probability of rebleeding was 22%. Ascites and hepatic encephalopathy was documented in 26% and 7% of patients, respectively, at least once during the clinical course. The 1-year probability of developing portal vein thrombosis (PVT) was 9%, and 53% of patients receiving anticoagulation achieved recanalization. Human immunodeficiency virus (HIV) infection and VB at diagnosis were the independent predictors of PVT. Seven patients died (6 as a result of an IPH-related cause) and 2 were transplanted. Probability of liver transplantation-free survival was 82% at 10 years. Presence of a severe associated disorder and ascites as a presenting symptom were associated with poor survival. Conclusion: Variceal bleeding is a major complication of IPH. Using, in IPH patients, the same management approach for PH as in cirrhosis is safe and maintains a low incidence of first bleeding and rebleeding in IPH patients. PVT is a frequent complication, particularly in those with HIV infection. Despite several complications, overall survival of patients with IPH is considerably good. (HEPATOLOGY 2014;59:2276-2285

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Idiopathic portal hypertension: Natural history and long-term outcome

et al. 2014

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“…Therefore, indication to TIPS must be evaluated on an individual patient basis Non-cirrhotic portal hypertension (NCPH) in HIV Non-cirrhotic portal hypertension (NCPH) has been reported as a liver disease in Human Immunodeficiency Virus (HIV)-infected patients under antiretroviral therapy (ART) [211] Combination of non-exclusive mechanisms has been described: primary endothelial damage of terminal portal veins induced by HIV or immunologic disorders, mitochondrial toxicity by didanosine and prothrombotic state [212]. It is characterized by heterogeneous liver histological findings, frequently identified as nodular regenerative hyperplasia and clinical manifestations of portal hypertension with well-preserved liver function [213,214].…”

Section: Session 6: Unusual Inications To Tips Placementmentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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“…Eine erhöhte exogene Glykierung wurde bei HIV-negativen Patienten mit erhöhtem kardiovaskulären Risiko nachgewiesen. Als ein unabhängiger Risikofaktor wurden die Dauer der HIV-Infektion (OR 1,2 pro 5 Jahre) und der antiretroviralen Therapie (OR 1,35 pro 5 Jahre) identifiziert [68,69]. HIV-positive Patienten haben ein höheres Risiko, bestimmte Krebsformen zu entwickeln als HIV-negative Menschen [70].…”

Section: Bedeutung Von Komorbiditätenunclassified

Neues bei HIV und Neuro-Aids

et al. 2015

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Zusammenfassung Trotz sehr effektiver Behandlungsoptionen f?r die systemische HIV-Infektion sind Neuro-Aids und die HIV-assoziierte neurokognitive St?rung ein klinisches und alltagsrelevantes Problem. Man unterscheidet 3 Stufen, das HIV-assoziierte, neuropsychologische Defizit (ANPD), das milde, HIV-assoziierte neurokognitive Defizit (MNCD) und die HIV-assoziierte Demenz (HAD). Die Behandlungsm?glichkeiten HIV-assoziierter neuro-kognitiver St?rungen umfasst die antiretrovirale Therapie (cART), die den CPE-Score zur Penetration der Medikamente ins ZNS ber?cksichtigen sollte. Es ist sinnvoll, bei Auftreten multiresistenter Virusvarianten im Blut auch im Liquor entsprechende Untersuchungen durchzuf?hren. Im peripheren Nervensystems treten neben der klassischen, distal-symmetrischen, HIV-assoziierten Polyneuropathie immunogen vermittelte Neuropathien oder Myopathien auf (CIDP, AIDP). Durch die antiretrovirale Therapie (cART) verursachte Polyneuropathien sind differenzialdiagnostisch zu ber?cksichtigen. Erworbene mitochondrial toxische Myopathien treten h?ufiger auf, da nun eine cART durchaus ?ber 10???20 Jahre durchgef?hrt wird. Bei Patienten mit schweren depressiven Episoden zeigte sich eine 6-mal h?here Wahrscheinlichkeit, die Einnahme der cART mindestens einmal zu vergessen. Depressive Episoden sind oft ein Grund f?r mangelhafte Adh?renz, korrelieren mit einer h?heren Viruslast und sind dringend zu behandeln. In den letzten Jahren kam es infolge der verbesserten cART zu einem R?ckgang der opportunistischen Infektionen (OI) des ZNS. Die h?ufigsten OI stellen die progressive multifokale Leukoenzephalopathie (PML), die Toxoplasma-Enzephalitis und die Kryptokokken-Meningitis dar. Bei rasch progredientem Verlauf einer OI muss an ein Immunrekonstitutionssyndrom (IRIS) gedacht werden. Es gibt momentan keine sichere Methode, z.?B. die Verschlechterung einer PML durch den nat?rlichen Krankheitsverlauf von der Verschlechterung durch ein IRIS zu unterscheiden. Infolge der deutlich zunehmenden Lebenserwartung treten Komorbidit?ten mehr in den Vordergrund. Zu den viralen Biomarkern f?r die Krankheitsaktivit?t im ZNS z?hlen Neopterin als Marker der Makrophagenaktivierung, das Neurofilament-Leichtprotein und das Gesamt-Tau-Protein.

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

Abstract: SUMMARY Background

Cited by 55 publications

References 29 publications

Idiopathic portal hypertension: Natural history and long-term outcome

Idiopathic portal hypertension: Natural history and long-term outcome

Consensus conference on TIPS management: Techniques, indications, contraindications

Neues bei HIV und Neuro-Aids

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