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.|
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.