Nodular regenerative hyperplasia of liver as a consequence of ART.

摘要

We found the report of Mallet et al. regarding the occurrence of nodular regenerative hyperplasia (NRH) in HIV patients tantalizing, particularly because we were recently confronted with a similar clinical conundrum in an HIV patient.A 27-year-old white homosexual man presented to the HIV clinic and complained of generalized weakness, upper abdominal pain/distension, daily heartburn, non-bloody diarrhea and excessive flatulence that had its onset 3 days after starting nevirapine, and exacerbated further when the dose of nevirapine was increased from 200 to 400 rag a day. He was previously doing well on a triple nucleoside analogue regimen including didanosine 250 mg and emtricitabine 200 mg/tenofovir 300 mg a day, with an undetectable HIV viral load and a CD4 cell count of 249 cells/mul, but nevirapine was substituted for didanosine 4 weeks before his current presentation in order to give diversity to his antiretroviral regimen. His past medical history was significant for gastroesophageal reflux disease, psoriasis and bipolar disorder. Besides the antiretroviral drugs, he used over-the-counter omepera-zole, dovonex 0.005% ointment and fluocinolone 0.01% cream as needed. He had used alcohol in moderate amounts during die past 6 years, using up to 13 units of alcohol on a weekly basis. He did not have any history of intravenous drug use. His physical examination revealed stable vital signs and moderate diffuse upper abdominal tenderness and no rashes.