A  41-year-old  Caucasian  woman  was  admitted  to  the hospital  in  July 1998,  because  of  Pneumocystis  jiroveci pneumonia,  oral  candidiasis  and  pulmonary  tuberculosis. HIV  infection  was  diagnosed  and  ART  with  didanosine, stavudine  and  nevirapine  was  started.  Two  years  later, progressive cholestasis appeared in blood test and infection with hepatitis B and hepatitis C virus was ruled out. In June 2003, the patient was admitted  to the hospital because of bleeding from grade  2-3 esophageal varices. Sclerosis and banding ligation were performed, but main portal vein stent placement was required to connect the portal vein to inferior vena cava. Abdominal Doppler ultrasound showed massive ascites, left branch portal and splenoportal vein nonocclusive thrombosis, as well as chronic liver disease. Autoimmunity parameters  disclosed  slightly  positive  anti-smooth  muscle and  negative  antinuclear,  antimitochondrial  and  anti-liver kidney  microsomal  antibodies.  She  was  evaluated  for hypercoagulable   state   and   was   found   to   have   low antithrombin III values at the time of hematemesis. Sixteen months later, low protein C and S values were found. A liver biopsy showed patchy sinusoidal dilatation and congestion, collapsed  liver  cell  plates  and  nodular  areas  without extensive fibrosis, all of these findings being suggestive of nodular regenerative hyperplasia. In April  2005, ART was changed   to   abacavir/lamivudine   and   lopinavir/ritonavir booster (didanosine was removed), due to virological failure and according to resistance test. An abdominal ultrasound performed  in  March 2009  showed  patent  shunt. Eight months later, CD4  cell count was  1005/mcl  (36  %), viral load  was  below 50  copies/ml,  and  the  patient  had  a satisfactory general condition.