Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis c virus-coinfected liver transplant recipients: A FIPSE/GESIDA Prospective Cohort Study

Abstract

Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range ¼ 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) ¼ 2.9, 95% confidence interval (CI) ¼ 1.5-5.8]. Independent factors for severe infections included a pre-

Outcome and management of HCV/HIV coinfection pre- and post-liver transplantation. A 2015 update

“…A multivariable analysis of the American cohort revealed a higher frequency of multisystem organ failure/sepsis in the coinfected group, likely the result of liver dysfunction related to severe HCV recurrence. The Spanish group reported that severe infections (defined as sepsis, bloodstream infections, invasive fungal infections, CMV disease, invasive viral infection, and mycobacterial disease) increased the mortality rate almost 3-fold [34]. In the American series, there were no graft losses related to HIVassociated infections or malignancies in the coinfected group.…”

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

“…Preemptive therapy has not been well studied in some seropositive populations, including lung, heart, vascularized composite, pancreas, islet, and intestinal transplantation; prophylaxis may be preferable (weak, low). & Prophylaxis may be preferred in other high-risk patients, including those on recent antilymphocyte therapy, potent immunosuppression including desensitization or ABOincompatible protocols (including those on rituximab, bortezomib, eculizumab, and plasmapheresis/immunoadsorption), and those with HIV (weak, moderate) (145). & Transplant recipients on mammalian target of rapamycin (mTOR) inhibitors such as sirolimus and everolimus may have lower rates of CMV; (146Y152) whether this should alter their prevention strategy is unknown.…”

HIV and viral hepatitis coinfections: advances and challenges

“…Most recently however, increased risk of infections was described in HIV infected liver transplant recipients with a history of AIDS, a high Model for End-Stage Liver Disease score or non-tacrolimus based immunosuppression 101. Accumulated experience in North America and Europe in the past 5 years indicated that 1 and 3 year survival rates in selected HIV infected recipients of liver transplants were almost similar to that of HIV negative recipients 102 103.…”