Reviewer's report
Title:Anticoagulant therapy for nodular regenerative hyperplasia in a
HIV-infected patient
Version: 2Date:24 September 2009
Reviewer: abdul nadir
Reviewer's report:
All comments are major compulsory
1. The authors write in discussion that perhaps changing therapy from DDI to
another ARV resulted in improvement in portal hypertension. The exposure of
ARV medication to this patient needs to be clarified. The authors should provide
more history of ARV exposure including start date of ARV therapy, changes in
the ARV regimen over time and how that correlated with improvement of portal
hypertension. It is entirely possible that reversal of portal hypertension occurred
as a result of ARV therapy and not anticoagulation therapy.
2. This patient had peritoneal tuberculosis. Peritoneal tuberculosis is another
cause of ascites. The authors need to clarify the status of peritoneal TB. They
should also outline the relevant therapy used for TB and the timeline of use of TB
medications. I have not come across TB medications causing NRH and authors
should state that it is not an etiology particularly if the timeline between TB
therapy and symptoms was simulataneous. It will be prudent to include ascitis
fluid analysis as well to show that it was consistent with portal hypertension
based on a SAAG ratio.
3. Please provide the work up for liver disease in the case report. what were the
hepatitis viral serologies. Also was autoimmune work up done including ANA and
quantitative immunoglobulins. Autoimmune diseases have been associated with
NRH as well.
4. The status of HIV disease should also be mentioned with T cell count and HIV
viral load as this is pertinent as well.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests.
Reviewer's report
Title:Anticoagulant therapy for nodular regenerative hyperplasia in a
HIV-infected patient
Version: 2Date:24 September 2009
Reviewer: abdul nadir
Reviewer's report:
All comments are major compulsory
1. The authors write in discussion that perhaps changing therapy from DDI to
another ARV resulted in improvement in portal hypertension. The exposure of
ARV medication to this patient needs to be clarified. The authors should provide
more history of ARV exposure including start date of ARV therapy, changes in
the ARV regimen over time and how that correlated with improvement of portal
hypertension. It is entirely possible that reversal of portal hypertension occurred
as a result of ARV therapy and not anticoagulation therapy.
2. This patient had peritoneal tuberculosis. Peritoneal tuberculosis is another
cause of ascites. The authors need to clarify the status of peritoneal TB. They
should also outline the relevant therapy used for TB and the timeline of use of TB
medications. I have not come across TB medications causing NRH and authors
should state that it is not an etiology particularly if the timeline between TB
therapy and symptoms was simulataneous. It will be prudent to include ascitis
fluid analysis as well to show that it was consistent with portal hypertension
based on a SAAG ratio.
3. Please provide the work up for liver disease in the case report. what were the
hepatitis viral serologies. Also was autoimmune work up done including ANA and
quantitative immunoglobulins. Autoimmune diseases have been associated with
NRH as well.
4. The status of HIV disease should also be mentioned with T cell count and HIV
viral load as this is pertinent as well.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Anticoagulant therapy for nodular regenerative hyperplasia in a
HIV-infected patient
Version: 2Date:24 September 2009
Reviewer: abdul nadir
Reviewer's report:
All comments are major compulsory
1. The authors write in discussion that perhaps changing therapy from DDI to
another ARV resulted in improvement in portal hypertension. The exposure of
ARV medication to this patient needs to be clarified. The authors should provide
more history of ARV exposure including start date of ARV therapy, changes in
the ARV regimen over time and how that correlated with improvement of portal
hypertension. It is entirely possible that reversal of portal hypertension occurred
as a result of ARV therapy and not anticoagulation therapy.
2. This patient had peritoneal tuberculosis. Peritoneal tuberculosis is another
cause of ascites. The authors need to clarify the status of peritoneal TB. They
should also outline the relevant therapy used for TB and the timeline of use of TB
medications. I have not come across TB medications causing NRH and authors
should state that it is not an etiology particularly if the timeline between TB
therapy and symptoms was simulataneous. It will be prudent to include ascitis
fluid analysis as well to show that it was consistent with portal hypertension
based on a SAAG ratio.
3. Please provide the work up for liver disease in the case report. what were the
hepatitis viral serologies. Also was autoimmune work up done including ANA and
quantitative immunoglobulins. Autoimmune diseases have been associated with
NRH as well.
4. The status of HIV disease should also be mentioned with T cell count and HIV
viral load as this is pertinent as well.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests.
assistant