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Idiopathic portal hypertension patients with variceal bleeding, HIV at greater risk for PVT

Idiopathic portal hypertension patients who experienced variceal bleeding or were HIV-infected had an increased risk for portal vein thrombosis, according to data from a recent study.

Researchers studied 69 patients diagnosed between December 1995 and December 2012 with portal hypertension, including 42% who were symptomatic at baseline. Patient follow-up (mean, 6.7 years) was every 6 months until March 2013.

Data revealed that variceal bleeding at diagnosis (HR=2.53; 95% CI, 1.13-5.67) and HIV infection (HR=4.99; 95% CI, 2.11-11.82) were associated with the development of portal vein thrombosis (PVT). PVT development was more common among HIV patients (n=15) than non-HIV patients (21% vs. 6%). Among non-HIV patients, bleeding at diagnosis and serum bilirubin were associated with PVT development. Twenty-eight percent of all patients experienced variceal bleeding.

The probability of developing PVT at 1 year was 9%, and 53% of patients receiving anticoagulation met recanalization. Seven patients died during follow-up, six were related to idiopathic portal hypertension (IPH), and two underwent transplant. Liver transplant-free survival rates were 100%, 98%, 86% and 82% at 1, 2, 5, and 10 years, respectively.

A majority of patients showed preserved liver function and normal albumin, as well as mild abnormality of liver enzymes, and researchers considered the overall survival rate of patients with IPH as “considerably good.”

“The present study shows that PVT is a frequent complication, exceptionally in a subgroup of IPH associated with HIV infection,” the researchers wrote. “We propose that IPH should be categorized based on the difference in the incidence of complications and prognosis.”

Disclosure: Researcher Jaume Bosch, MD, is a consultant for Gilead Sciences, Norgine and Microtech and has received grants from Microtech.