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 25 November 2017

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News

Liver transplantation in HIV-infected patients: the impact of HCV and HBV infection

October's issue of Liver Transplantation provides a report into liver transplantation as a therapeutic option for HIV positive patients infected with hepatitis C or B.

News image

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Liver transplantation (LT) in human immunodeficiency virus (HIV)-positive individuals is considered to be an experimental therapy with limited reported worldwide experience, and little long-term survival data.

At present, published data suggest that the short-term outcome is encouraging in selected patients.

The Institute of Liver Studies at King's Hospital in London has submitted a report on 14 HIV-infected liver allograft recipients.

Researchers compared the outcomes from this group with patients coinfected with hepatitis C virus (HCV) and a non-HCV group.

A total of 14 HIV-infected patients (12 male, 2 female, age range 26-59 years) underwent LT between January 1995 and April 2003.

The indications for LT were HCV (n = 7), hepatitis B virus (HBV; n = 4), alcohol-induced liver disease (n = 2), and seronegative hepatitis (n = 1); 3 patients presented with acute liver failure.

At LT, researchers found that CD4 cell counts (T-helper cells that are targets for HIV) ranged from 124 to 500 cells/microL (mean 264), and HIV viral loads from <50 to 197,000 copies/mL.

LT is an acceptable therapeutic option in selected HIV patients.

Liver Transplantation

The research group exposed 9 out of the 12 patients to highly active antiretroviral therapy (HAART) before LT.

In the non-HCV group (n = 7), all patients are alive, all surviving more than 365 days (range 668-2,661 days).

The researchers had no patients experiencing HBV recurrence, and graft function was found to be normal in all 7 patients.

However, the researchers reported that 5 of 7 HCV-infected patients died after LT at 95-784 days (median 161 days).

A total of 4 patients died of complications due to recurrent HCV infection and sepsis, despite antiviral therapy in 3 of them.

A total of 3 patients experienced complications relating to HAART therapy.

The group concluded that these results of LT in HIV-infected patients with HBV or other causes of chronic liver disease indicate that LT is an acceptable therapeutic option in selected patients.

However, they asserted that longer follow-up in a larger series is required before a conclusive directive can be provided for HCV / HIV coinfected patients requiring LT.

Liver Transplantation;2004;10:1271-1278.)
23 September 2004

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