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Pediatr Infect Dis J. 2016 Aug;35(8):e248-52. doi: 10.1097/INF.0000000000001202.

Noncirrhotic Portal Hypertension in Perinatally HIV-infected Adolescents Treated With Didanosine-containing Antiretroviral Regimens in Childhood.

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From the *Department of Pediatric Hematology, Immunology and Infectious Diseases, and †Department of Pathology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands; ‡Department of Pathology, MCH-Bronovo Hospital, The Hague, The Netherlands; §Faculty of Medicine, Chulalongkorn University and HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand; ¶U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, & Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, ‖Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of **Radiodiagnostics and ††Infectious Diseases, AMC; and ‡‡Department of Pediatric Gastroenterology, Emma Children's Hospital, AMC, Amsterdam, The Netherlands.



Noncirrhotic portal hypertension (NCPH) has been reported in HIV-infected adults. Antiretroviral drugs, as well as genetic and thrombophilic predisposition, have been suggested as possible etiologic factors.


Clinical data were collected from 6 HIV-infected patients attending the Infectious Diseases Departments at respectively Emma Children's Hospital Academic Medical Centre in Amsterdam, The Thai Red Cross AIDS Research Centre, Bangkok, Imperial College Healthcare NHS Trust, London who were diagnosed with NCPH. All underwent extensive blood analysis, liver ultrasound, liver elastography, esophagogastroduodenoscopy and percutaneous needle liver biopsy for histological evaluation.


We describe 6 perinatally HIV-infected adolescents, all female, who developed NCPH after prolonged exposure during childhood to a didanosine-containing antiretroviral regimen. Histology and electron microscopy showed periportal fibrosis and mitochondrial damage as key findings in their liver biopsies. One of these 6 patients required surgical intervention, the remainder have been managed conservatively to date.


Thus, symptomatic NCPH may present in adolescence after perinatally acquired HIV-1 infection. In this case series, risk factors included female sex and prolonged exposure to antiretroviral regimens that included the nucleoside-analogue didanosine in childhood.

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