Liver Transplantation in HIV-HCV Coinfected Patients: A Case-Control Study

Abstract

Liver transplantation (LT) for hepatitis C virus (HCV)-associated cirrhosis in human immunodeficiency virus (HIV)-infected patients was compared with non-HIV patients. Nine patients with HIV-HCV coinfection were compared with patients transplanted before and after each HIV patient (control group). Immunosuppression consisted in tacrolimus with steroids or mycophenolate mofetil. Acute cellular rejection and three-year actuarial patient survival were respectively 44% and 87.5% in HIV group and 22% and 93.7% in the control group (P=NS). Acute hepatitis C virus occurred earlier (2.3 vs. 4.3 months) and was more cholestatic (mean bilirubin: 10.8 vs. 1.6 mg/dL) in the HIV group. Eight (100%) HIV and nine (64.3%) control patients received antiviral treatment with pegylated interferon and ribavirin. One patient (11.1%) of the control group and one patient (20%) of the HIV group presented a sustained virologic response (P=NS). Short- to midterm results of LT in HIV-HCV co-infected patients were excellent and similar to non-HIV patients.

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…134,135 FCH and sepsis are the leading causes of death in HCV and HIV coinfected patients. [136][137][138] With the availability of DAA for the treatment of recurrent HCV following liver transplantation, SVR rates have improved in HCV and HIV coinfected patients. 139,140 The indications for liver transplantation in HCV and HIV coinfected patients are similar to those for noninfected patients.…”

Liver transplantation in human immunodeficiency virus-positive patients

“…66,69 HCV recurrence, particularly the aggressive, severe cholestatic form and sepsis are the leading causes of death post-LT in HIV/HCV-coinfected patients. [64][65][66][70][71][72] Reassuringly, sepsis does not seem to be opportunistic in nature. In a French study of 35 HIV/HCV-coinfected patients, the fibrosis scores were significantly higher than those of HCV-monoinfected patients 24 months post-LT (2.4 versus 1.4, P ¼ 0.01).…”

“…76,81 cART should be reintroduced once the liver graft function has normalized to avoid confusion with other causes of graft dysfunction in the immediate posttransplant period. Table 5 summarizes the course of HIV disease post-LT. Current data highlight a low incidence of opportunistic infections in patients who are re-established on cART and undergo successful immune reconstitution post-LT. 63,65,[70][71][72][73]82 The majority of HIV-related complications appear to be related to cART and druginduced liver injury.…”

Liver transplantation in HCV/HIV positive patients

“…An exception, though, is the report by Schreibman et al [45] that HIV-infected patients experienced significantly higher mortality from infectious complications (4 of 15 recipients). The results of HCC cases within Milan-criteria are encouraging and there are no reports of recurrences [33,35,45,48,49,[51][52][53][54] .…”