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New Cause of Chronic Liver Disease Identified in HIV-positive Patients

A new cause of liver disease has been identified in HIV-positive patients. Investigators in Paris found that 8% of HIV-infected individuals receiving treatment// at a specialist liver centre had nodular regenerative hyperplasia, a rare, but potentially fatal, liver disease.

The syndrome involves the build-up of pressure in the portal vein, which connects the intestines with the liver and can cause bleeding into the stomach. Writing in the January 11th edition of the journal AIDS, the French investigators suggest that nodular regenerative hyperplasia is probably under-diagnosed in HIV-positive patients with liver disease, and that antiretroviral therapy should be carefully examined as a possible cause.

Liver disease is an important cause of illness and death amongst HIV-positive individuals. The main causes of chronic liver disease in people with HIV are coinfection with hepatitis B or hepatitis C virus; illict drug or alcohol use; insulin resistance; or medication side-effects.

In some patients, the cause of liver disease is unknown and these cases are designed “cryptogenic” - of unknown origin. Liver disease of unknown origin in HIV-positive patients has previously never been fully described, meaning that its causes, clinical importance, and prognosis are unknown.

Investigators in Paris speculated that the rare, but serious, liver disease, nodular regenerative hyperplasia (NRH) could be causing liver disease that could not be attributed to other causes, in HIV-positive patients. NRH is characterised by the presence of widespread regenerative nodules on the liver without significant fibrosis being present. It has previously been observed in a single HIV-positive individual, and was thought to be due to interleukin-2 therapy.

Between early 2003 and mid-2006, a total of 97 HIV-positive patients had liver biopsies at the Necker University Hospital in Paris. Eight of these individuals were diagnosed as hav
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