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AIM To identify significant liver disease [including nodular regenerative hyperplasia(NRH)] in asymptomatic Didanosine(DDI) exposed human immunodeficiency virus(HIV) positive patients.METHODS Patients without known liver disease and with > 6 mo previous DDI use had liver stiffness assessed by transient elastography(TE). Those with alanine transaminase(ALT) above upper limit normal and/or TE > 7.65 k Pa underwent ultrasound scan(U/S). Patients with:(1) abnormal U/S; or(2) elevated ALT plus TE > 7.65 k Pa;or(3) TE > 9.4 k Pa were offered trans-jugular liver biopsy(TJLB) with hepatic venous pressure gradient(HVPG) assessment.RESULTS Ninety-nine patients were recruited, median age 50 years(range 31-70), 81% male and 70% men who have sex with men. Ninety-five percent with VL < 50 copies on antiretroviral therapy with median CD4 count 639 IU/L. Median DDI exposure was 3.4 years(range 0.5-14.6). Eighty-one had a valid TE readings(interquartile range/score ratio < 0.3): 71(88%) < 7.65 k Pa, 6(7%) 7.65-9.4 k Pa and 4(6%) > 9.4 k Pa. Seventeen(17%) met criteria for TJLB, of whom 12 accepted. All had HVPG < 6 mm Hg. Commonest histological findings were steatosis(n = 6), normal architecture(n = 4) and NRH(n = 2), giving a prevalence of previously undiagnosed NRH of 2%(95%CI: 0.55%, 7.0%).CONCLUSION A screening strategy based on TE, liver enzymes and U/S scan found a low prevalence of previously undiagnosed NRH in DDI exposed, asymptomatic HIV positive patients. Patients were more likely to have steatosis highlighting the increased risk of multifactorial liver disease in this population.
AIM To identify significant liver disease [including nodular regenerative hyperplasia (NRH)] in asymptomatic Didanosine (DDI) exposed human immunodeficiency virus (HIV) positive patients. METHHODS Patients without known liver disease and with> 6 mo previous DDI use had liver stiffness assessed by Those with alanine transaminase (ALT) above upper limit normal and / or TE> 7.65 k Pa underwent ultrasound scan (U / S). Patients with: (1) abnormal U / S; or Nine patients were recruited trans-jugular liver biopsy (TJLB) with hepatic venous pressure gradient (HVPG) assessment .RESULTS Ninety-nine patients were recruited, median age 50 years (ALT plus TE> 7.65 kPa; Ninety-five percent with VL <50 copies on antiretroviral therapy with median CD4 count 639 IU / L. Median DDI exposure was 3.4 years (range 0.5-31, range 31-70), 81% male and 70% men who have sex with men. Eighty-one had a valid TE readings (interquartile range / score ratio <0.3): 71 (88%) <7.65 kPa, 6 ( Seventeen (17%) met criteria for TJLB, of whom 12 was eligible. All had HVPG <6 mm Hg. Commonest histological findings were steatosis (n = 7%) 7.65-9.4 kPa and 4 6), normal architecture (n = 4) and NRH (n = 2), giving a prevalence of previously undiagnosed NRH of 2% (95% CI: 0.55%, 7.0% and U / S scan found a low prevalence of previously undiagnosed NRH in DDI exposed, asymptomatic HIV positive patients. Patients were more likely to have steatosis highlighting the increased risk of multifactorial liver disease in this population.