The role of nucleoside and nucleotide analogues in nodular regenerative hyperplasia in HIV-infected patients: A case control study

• Published in: Journal of hepatology 2011-03, Vol.54 (3), p.489-496
• Main Authors: Cotte, Laurent, Bénet, Thomas, Billioud, Claire, Miailhes, Patrick, Scoazec, Jean-Yves, Ferry, Tristan, Brochier, Corinne, Boibieux, André, Vanhems, Philippe, Chevallier, Michèle, Zoulim, Fabien
• Format: Article
• Language: English
• Subjects: Adenine; Adenine - adverse effects; Adenine - analogs & derivatives; Adult; Anti-HIV Agents; Anti-HIV Agents - adverse effects; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiretroviral Therapy, Highly Active - adverse effects; Antiviral agents; Biological and medical sciences; Cancer; Case-Control Studies; Didanosine; Didanosine - adverse effects; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; HIV; HIV Infections; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - pathology; Human viral diseases; Humans; Hyperplasia; Hypertension, Portal; Hypertension, Portal - etiology; Infectious diseases; Life Sciences; Liver; Liver - drug effects; Liver - pathology; Liver Regeneration; Liver Regeneration - drug effects; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Nodular regenerative hyperplasia; Non-cirrhotic portal hypertension; Nucleoside; Organophosphonates; Organophosphonates - adverse effects; Other diseases. Semiology; Pharmacology. Drug treatments; Reverse Transcriptase Inhibitors; Reverse Transcriptase Inhibitors - adverse effects; Stavudine; Stavudine - adverse effects; Tenofovir; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2010.07.030

Background & Aims Nodular regenerative hyperplasia (NRH) leading to non-cirrhotic portal hypertension has been described in HIV-infected patients and has been linked to didanosine. The relation between NRH and other antiretrovirals remains unclear. Methods A case-control study was performed in 13 patients with NRH and 78 controls matched for time of inclusion, baseline CD4, and duration of follow-up. Univariate and multivariate conditional logistic regression analyses were performed. Results Control patients and patients with NRH were similar at baseline regarding demographics and biological data with the exception of older age for patients with NRH (43.9 vs. 33.5 years, p = 0.044). At the time of NRH diagnosis, cases had a lower CD4 count (327 vs. 468/mm3 , p = 0.013), a similar CD4 percentage (24 vs. 26.2%, p = 0.7), a lower platelet count (169 vs. 228 giga/L, p = 0.003) and a higher AST level (33 vs. 26 IU/L, p = 0.001) than controls. Univariate analysis demonstrated that patients with NRH had been exposed longer than controls to didanosine, stavudine, tenofovir, didanosine + stavudine, and didanosine + tenofovir. The age at baseline [OR 2.2 (1.0–5.0) per 10 years, p = 0.053] and didanosine + stavudine cumulative exposure [OR 3.7 (1.4–10.2) per year, p = 0.011] were independently associated with NRH. The age at baseline [OR 2.3 (1.0–5.3) per 10 years, p = 0.045], cumulative exposure to didanosine [OR 1.4 (1.1–1.9) per year, p = 0.023] and to tenofovir [OR 1.7 (1.0–2.8) per year, p = 0.04] were independently associated with NRH when didanosine + stavudine exposure was excluded from the model. Conclusions NRH in HIV-infected patients seems strongly related to age and the cumulative exposure to didanosine + stavudine, didanosine, and stavudine.