Systematic Review
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World J Hepatol. Jan 27, 2014; 6(1): 55-63
Published online Jan 27, 2014. doi: 10.4254/wjh.v6.i1.55
Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review
Archita Sood, Mariana Castrejón, Sammy Saab
Archita Sood, Department of Medicine, Olive View Medical Center, Sylmar, CA 91342, United States
Mariana Castrejón, Department of Surgery, University of California at Los Angeles Medical Center, Los Angeles, CA 90095, United States
Sammy Saab, Departments of Medicine and Surgery, University of California at Los Angeles Medical Center, Los Angeles, CA 90095, United States
Author contributions: Saab S designed research; Saab S and Sood A performed research; Saab S, Castrejón M and Sood A analyzed data; Saab S and Sood A wrote the paper.
Correspondence to: Sammy Saab, MD, MPH, AGAF, Departments of Medicine and Surgery, University of California at Los Angeles Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, United States. ssaab@mednet.ucla.edu
Telephone: +1-310-2066705 Fax: +1-310-2064197
Received: July 14, 2013
Revised: October 16, 2013
Accepted: December 12, 2013
Published online: January 27, 2014
Abstract

AIM: To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (HIV).

METHODS: We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: “nodular regenerative hyperplasia”, “human immunodeficiency virus”, “noncirrhotic portal hypertension”, “idiopathic portal hypertension”, “cryptogenic liver disease”, “highly active antiretroviral therapy” and “didanosine”. The bibliographies of these studies were subsequently searched for any additional relevant publications.

RESULTS: The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension – namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH.

CONCLUSION: The appropriate management of HIV-infected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.

Keywords: Human immunodeficiency virus, Nodular regenerative hyperplasia, Ascites, Systematic review, Liver complications

Core tip: Liver complications in patients with human immunodeficiency virus (HIV) is emerging as a public health concern. The appropriate management of HIV-infected persons with suspected nodular regenerative hyperplasia (NRH) is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence. We believe the implications of our manuscript will have immediate clinical implications.