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

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• 作者：Laurent Cotte¹ ; ² ; ^{laurent.cotte@chu-lyon.fr} ; Thomas Bé ; net³ ; Claire Billioud¹ ; Patrick Miailhes¹ ; ² ; Jean-Yves Scoazec¹ ; ³ ; Tristan Ferry¹ ; ³ ; Corinne Brochier¹ ; André ; Boibieux¹ ; Philippe Vanhems¹ ; ³ ; Michè ; le Chevallier⁴ ; Fabien Zoulim¹ ; ² ; ³
• 关键词：Nodular regenerative hyperplasia ; Non-cirrhotic portal hypertension ; HIV ; Nucleoside ; Didanosine ; Stavudine ; Tenofovir
• 刊名：Journal of Hepatology
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：54
• 期：3
• 页码：489-496
• 全文大小：770 K

文摘

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.