Objectives:To assess the utility of spleen stiffness as a diagnostic tool inindividuals withHIV andnon-cirrhotic portal hypertension(NCPH).Design:The Philips EPIQ7TM, a newpoint shearwave elastography (pSWE) technique, was used to assess liver and spleen stiffnessin3 patient groups. Group1:HIV and NCPH(n=11); Group 2: HIV withpast didanosine(ddI) exposure without known liver disease or NCPH(n=5), Group 3: HIV without known liver disease or ddI exposure(n=9). Methods:Groups were matched for age, HIV chronicity and antiretroviral treatment (including cumulative ddI exposure in Groups 1 and 2). Differences in liver and spleen stiffness (in kPa) between groups were analysed using the Mann-Whiney U test.Results:Liver and spleen stiffness were both significantly higher in NCPH vs ddI-exposed (p=0.019 and p=0.006) and ddI-unexposed controls (p=0.038 and p<0.001). Spleen stiffness was more effective than liver stiffness at predicting NCPH, AUROC 0.812 vs 0.948. Combining the two variables improved the diagnostic performance, AUROC 0.961. The optimal cut-off for predicting NCPH using splenic stiffness was 25.4kPa, with sensitivity 91%, specificity 93%, PPV 91%, NPV 93%, positive likelihood ratio 12.73, negative likelihood ratio 0.10. Spleen and liver stiffness scores were strongly correlated (p=0.0004 95%CI 18,59). Conclusions:Elevated spleen stiffness is observed in HIV with NCPH and can be quantified easily using pSWE with high diagnostic accuracy. Novel strategies such as pSWE for longitudinal monitoring of patients with HIV and NCPH should be considered.