Clutterbuck, D

Fox, R

Jackson, C

Peters, E

Priest, M

English

PubMed

C Jackson

R Fox

M Priest

D Clutterbuck

E Peters

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Journal of the International AIDS Society

A case of nodular regenerative hyperplasia in a patient who had been taking didanosine

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POSTER PRESENTATION Open Access
A case of nodular regenerative hyperplasia in a
patient who had been taking didanosine
C Jackson1*, R Fox1, M Priest2, D Clutterbuck3, E Peters1
From Tenth International Congress on Drug Therapy in HIV Infection
Glasgow, UK. 7-11 November 2010
Purpose of study
It is widely recognised that liver disease causes significant
morbidity and mortality in HIV positive patients. Many
patients are co-infected with hepatitis B and C, have
increased alcohol intake or are on hepatotoxic medica-
tion e.g. nevirapine, which can cause acute hepatitis or
liver cirrhosis. Nodular regenerative hyperplasia (NRH) is
characterised by the presence of diffuse, small regenera-
tive nodules in the absence of significant cirrhosis. Prior
use of didanosine is associated with NRH. It leads to por-
tal hypertension, oesophageal varices and subsequent
gastrointestinal haemorrhage.
Methods
A 53-year-old gentleman presented with a major upper
gastrointestinal haematemesis. He was diagnosed with
HIV 23 years previously and had been on treatment for
the last 13 years, maintaining an undetectable viral load
and reasonable CD4 count. He denied significant alcohol
and a full liver screen was negative. He was taking zidovu-
dine, didanosine and nevirapine from 1997 to 2005, when
he was switched to tenofovir, nevirapine and lamivudine.
He continued on this combination until 2009 when his
tenofovir and lamivudine were replaced with Truvada.
Summary of results
Liver function tests at the time of admission revealed
AST-15, ALT-20, Bilirubin-5, GGT-78. Endoscopy
showed bleeding oesophageal varices, which were treated
with variceal band ligation (VBL). Despite this he had
two further episodes of bleeding, requiring a transjugular
intrahepatic portosystemic shunt (TIPPS). Liver biopsy
demonstrated focal nodularity within the parenchyma
consistent with NRH but no evidence of fibrosis.
Conclusions
This gentleman had been on didanosine from 1997 to
2005 and it is recognised that this is a risk factor for
NRH. It is hypothesised that didanosine, which is a pur-
ine analogue, causes destruction of portal veins. Amino-
transferases may be normal or elevated. In patients with
a previous history of didanosine use, physicians should
be aware of the risk of portal hypertension without cir-
rhosis, which can lead to catastrophic outcomes.
Author details
1Brownlee Center, Infectious diseases, Glasgow, UK. 2Gartnevel General
Hospital, Gastroenterology, Glasgow, UK. 3Lauriston Building, GUM,
Edinburgh, UK.
Published: 8 November 2010
doi:10.1186/1758-2652-13-S4-P94
Cite this article as: Jackson et al.: A case of nodular regenerative
hyperplasia in a patient who had been taking didanosine. Journal of the
International AIDS Society 2010 13(Suppl 4):P94.
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Jackson et al. Journal of the International AIDS Society 2010, 13(Suppl 4):P94
http://www.jiasociety.org/content/13/S4/P94
© 2010 Jackson et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
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A case of nodular regenerative hyperplasia in a patient who had been taking didanosine

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