Severe Liver Disease Associated With Prolonged Exposure to Antiretroviral Drugs

Maida, Ivana; Núñez, Marina; Rios, María; Martín-Carbonero, Luz; Sotgiu, Giovanni; Toro, Carlos; Rivas, Pedro; Barreiro, Pablo; Mura, María Stella; Babudieri, Sergio; García‐Samaniego, J.; González-Lahoz, Juan; Soriano, Vincent

doi:10.1097/01.qai.0000221683.44940.62

Cited by 150 publications

(132 citation statements)

References 47 publications

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“…More recently, some cases of non-cirrhotic portal hypertension have been described in HIV-infected patients (26)(27)(28)(29). In such cases, liver biopsy usually showed vascular lesions presenting as nodular regenerative hyperplasia.…”

Section: Hbv/hcv Co-infectionmentioning

confidence: 99%

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Salmon‐Céron

Rosenthal

Lewden

et al. 2009

Journal of Hepatology

106

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Section: Hbv/hcv Co-infectionmentioning

confidence: 99%

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Salmon‐Céron

Rosenthal

Lewden

et al. 2009

Journal of Hepatology

106

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“…Available information points toward didanosine as the antiretroviral agent linked to cases of noncirrhotic portal hypertension, which should discourage use of this agent. 100,109 With the continued decrease in its use, this complication should fade away and disappear over time. A conclusion which may be drawn from these cases of nodular regenerative hyperplasia is the need to obtain image studies, and in selected cases, also liver biopsy for diagnosis when HIV-infected patients have persistent and unexplained liver enzyme elevation while on HAART.…”

Section: Prevention and Management Of Haart Liver Toxicitymentioning

confidence: 99%

“…Of more concern is the report by Spanish authors of nine cases of portal hypertension complicated by variceal bleeding, ascites, or hepatic encephalopathy without known underlying liver disease. 100,101 Five patients were thought likely to have fibrosis, either through liver biopsy or transient elastography. Of note, portal thrombosis occurred in six cases.…”

Section: Acute Eventsmentioning

confidence: 99%

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Núñez

2010

Hepatology

Self Cite

160

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Highly active antiretroviral therapy (HAART)-related hepatotoxicity complicates the management of patients infected with human immunodeficiency virus (HIV), increases medical costs, alters the prescription patterns, and affects the guideline recommendations. Among the clinical consequences derived from HAART-related liver toxicity, hypersensitivity reactions and lactic acidosis are recognized as acute events with potential to evolve into fatal cases, whereas there seems to be other syndromes not as well characterized but of equal concern as possible long-term liver complications. Belonging to the latter category of syndrome, HAART-related nonalcoholic steatohepatitis, liver fibrosis, portal hypertension, and nodular regenerative hyperplasia are discussed in this review. Updated information on liver toxicity of current antiretroviral drugs, including the most recently licensed, is provided. Management and prevention of liver toxicity among HIV-infected patients treated with HAART are reviewed as well.

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“…NRH can be related to conditions in which hepatic blood flow is altered [9]. PVT is usually a result of an underlying vascular abnormality and has also been found to occur at greater rates in HIV-infected patients with liver disease than in the general population [4]. Schiano et al [29] reported a series of HIV-infected patients with hepatoportal sclerosis (HPS), which may be attributed to intrahepatic microthrombi.…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic liver disease in HIV‐seropositive men

Dinh

Stosor

Rao³

et al. 2009

HIV Medicine

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Objectives In the era of highly active antiretroviral therapy (HAART), liver disease has become a leading cause of morbidity and mortality in HIV‐seropositive individuals. Although liver disease is commonly caused by viral co‐infection, it has also been described in patients without viral hepatitis. In this study, we determined clinical factors associated with the development of cryptogenic liver disease in HIV‐infected individuals. Methods HIV‐seropositive and ‐seronegative patients undergoing evaluation for liver transplantation were selected if they met clinical criteria for cryptogenic liver disease. Clinical data were collected retrospectively, and radiological and histological data were reviewed separately. Results Nine HIV‐seropositive individuals were compared with 41 HIV‐seronegative patients with cryptogenic liver disease. Only one HIV‐seropositive patient (11%) had cirrhosis, compared to 39 HIV‐seronegative patients (93%) (P<0.001). Three HIV‐infected patients (33%) had histological evidence of nodular regenerative hyperplasia. HIV‐seropositive patients had significantly lower body mass indices, and lower Child–Pugh–Turcotte and Model for Endstage Liver Disease scores than HIV‐seronegative patients (P<0.05). Conclusions Advanced cryptogenic liver disease in HIV‐infected patients is infrequently caused by cirrhosis, and more frequently by nodular regenerative hyperplasia. This disease entity may become more common in the HAART era, and may contribute to an increased morbidity in HIV‐infected individuals.

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Severe Liver Disease Associated With Prolonged Exposure to Antiretroviral Drugs

Abstract: CLD is an uncommon condition in HIV-positive individuals and might be associated with prolonged didanosine exposure. It may evolve causing severe liver complications, with variceal bleeding and portal thrombosis being particularly frequent.

Cited by 150 publications

References 47 publications

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Clinical Syndromes and Consequences of Antiretroviral-Related Hepatotoxicity5, 1, 3

Cryptogenic liver disease in HIV‐seropositive men

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