Clinical

Hepatoportal sclerosis may underlie portal hypertension in HIV

Last Updated: 2007-11-12 16:12:44 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Certain HIV patients presenting with variceal bleeding may have hepatoportal sclerosis as a noncirrhotic cause of portal hypertension, according to New York City-based researchers. They present case reports on four such patients in the November issue of the American Journal of Gastroenterology.

All of the patients were men and ranged in age from 35 to 60 years, Dr. Isabel Fiel of The Mount Sinai Medical Center and colleagues note. All had variceal bleeding and two required transjugular intrahepatic porto-systemic shunt placement.

Needle liver biopsies did not show cirrhosis, but histological findings in all four patients included dense portal fibrosis and phlebosclerosis, seen as marked thickening of the portal vein wall that resulted in partial occlusion of the lumen.

The researchers postulate that the condition "may be due to intrahepatic microthrombosis or an altered hepatic fibrogenesis related to highly active antiretroviral therapy or due to HIV itself."

In any case, Dr. Fiel told Reuters Health, "Noncirrhotic portal hypertension due to hepatoportal sclerosis should be considered in the differential diagnosis when assessing HIV patients presenting with variceal bleeding. Pathologists and clinicians alike should be aware of this entity."

Am J Gastroenterol 2007;102:2536-2540.