HIV 相关性特发性非肝硬化性门静脉高压的危险因素和预后。

Risk factors and outcome of HIV-associated idiopathic noncirrhotic portal hypertension.

机构信息

Department of Gastroenterology Hepatology, University Hospital Rotterdam, Rotterdam, the Netherlands.

出版信息

Aliment Pharmacol Ther. 2012 Nov;36(9):875-85. doi: 10.1111/apt.12049.

DOI:10.1111/apt.12049

PMID:22971050

Abstract

BACKGROUND

Idiopathic noncirrhotic portal hypertension (INCPH) has been reported increasingly in patients with HIV infection.

AIM

To evaluate the number of nationwide diagnosed HIV-associated INCPH cases and to assess its clinical features, risk factors and outcome.

METHODS

All HIV centres in the Netherlands were contacted and requested to notify INCPH cases diagnosed in their population. A case–control study was performed to identify the risk factors of INCPH. The cases were group-matched for duration of follow-up after HIV diagnosis to controls. Controls were selected from a database of HIV patients with negative screening for signs of portal hypertension on abdominal ultrasound. Univariate and multivariate conditional logistic regression analyses were performed.

RESULTS

On 1st of July 2011, 18.085 individuals were infected with HIV in the Netherlands. Within this population, sixteen patients with clinically overt INCPH were identified. At the time of INCPH diagnosis, cases had a lower platelet count and a higher ALT level. In univariate and multivariate analyses, didanosine [OR: 1.9 (1.3–2.8)], concomitant didanosine and stavudine treatment [OR: 6.3 (2.1–19.1)] and concomitant didanosine and tenofovir treatment [OR: 5.1 (1.2–22.6)] were independently associated INCPH. During follow-up, 4 patients died [malignancy (n = 3), liver failure (n = 1)]. A significant decline in platelets was observed after didanosine discontinuation (P = 0.003).

CONCLUSIONS

HIV-associated clinically relevant idiopathic noncirrhotic portal hypertension appears to be a rarely diagnosed disease. Long-term exposure to didanosine and short-term combination of didanosine and stavudine or tenofovir exposure are associated with idiopathic noncirrhotic portal hypertension. Mortality in HIV-associated idiopathic noncirrhotic portal hypertension is mainly related to HIV-associated disorders. Portal hypertension continues despite didanosine discontinuation

摘要

背景

特发性非肝硬化门静脉高压症（INCPH）在 HIV 感染者中越来越多地被报道。

目的

评估全国诊断的 HIV 相关 INCPH 病例数量，并评估其临床特征、危险因素和结局。

方法

联系荷兰所有的 HIV 中心，并要求他们报告在其人群中诊断出的 INCPH 病例。进行病例对照研究以确定 INCPH 的危险因素。将病例按 HIV 诊断后随访时间与对照组进行分组匹配。对照组从 HIV 患者数据库中选择，这些患者的腹部超声筛查均无门静脉高压征象。进行单因素和多因素条件逻辑回归分析。

结果

2011 年 7 月 1 日，荷兰有 18085 人感染了 HIV。在这一人群中，发现了 16 例临床表现明显的 INCPH 患者。在 INCPH 诊断时，病例的血小板计数较低，ALT 水平较高。在单因素和多因素分析中，地达诺辛[OR：1.9（1.3-2.8）]、地达诺辛和司他夫定联合治疗[OR：6.3（2.1-19.1）]和地达诺辛和替诺福韦联合治疗[OR：5.1（1.2-22.6）]与 INCPH 独立相关。在随访期间，有 4 例患者死亡[恶性肿瘤（n=3），肝衰竭（n=1）]。地达诺辛停药后观察到血小板显著下降（P=0.003）。