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Survival in HIV-infected individuals following liver transplantation is influenced by viral co-infection: the negative impact of HCV infection
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This study was reported at the 9th Annual Conference by the British HIV Association, by these researchers S Norris, C Taylor, C McDonald, J O'Grady, BC Portmann, AS Knisely, M Bowles, P Muiesan, M Rela and N Heaton at King's College Hospital, London, UK.
A number of reports of studies have been presented at various HIV and hepatitis scientific conferences over the past few years on liver transplantation in HIV+ individuals with hepatitis C (HCV) or hepatitis B (HBV). The University of Pittsburgh has been a pioneer in providing liver transplants to HIV+ individuals and they have reported success comparable to that found in HIV-negative individuals. Liver transplantation in HIV+ individuals has also been reported to have been successful and comparable to results seen in HIV-negative individuals at other University-based liver transplant centers including the University of Miami, University of California at San Francisco (USCF), and others. The study reported at the British HIV Association Conference was conducted at Kings College in London. This appears to me to be the only center that has an unsuccessful experience in liver transplantation in HCV/HIV coinfected patients, although they showed success in HBV/HIV coinfected patients. They have previously reported on their experiences in liver transplants in HIV+ individuals at various scientific conferences. I don't think we understand why the transplants at Kings College were less successful in HCV/Hiv coinfected patients. Perhaps it's related to techniques and the patient characteristics. But it would be helpful if someone would study why Kings College has had these results to see if there are differences between their patients and methods and those at other sites having better results. The Kings College researchers had more success in transplanting HBV/HIV coinfected than HCV/HIV coinfected; when transplanting livers in HIV-negative individuals transplants are more successful in HBV+ individuals than in HCV+ individuals. Here is the abstract they reported in the conference program.
Introduction: Liver transplantation (LT) in HIV-positive individuals is still considered to be an experimental therapy with limited worldwide experience, and few long-term survival data. Published data suggest that the short-term outcome after LT is encouraging in selected patients. In the current study, we report our experience in 12 HIV-positive liver allograft recipients, and compare the outcomes of those co-infected with hepatitis C virus (HCV) to the non-HCV group.
Methods: 12 HIV-infected patients (10 male, two female, age range 26-59 years) underwent LT between January 1995 and March 2002. Indications for LT were HCV (n=5), hepatitis B virus (HBV) (n=4), ALD (n=2), and non-A, non-B hepatitis (n=1); three patients presented with acute liver failure. At LT, CD4 counts were 124-500 cells/µl (mean 267), and HIV viral loads from <50 to 197,000 copies/ml. Seven of 12 patients were exposed to highly active antiretroviral therapy (HAART) prior to LT.
Results: In the non-HCV group (n=7), all patients are alive, with five surviving more than 365 days (range 4-67 months). No patient experienced HBV recurrence, and graft function is normal in all seven recipients. In contrast, all HCV-infected patients died after LT at 95- 784 days (median 161). Four patients died of complications due to recurrent HCV infection and sepsis, despite antiviral therapy in three. Three patients experienced complications relating to HAART therapy.
Conclusions: The long-term outcome of LT in HIV-infected patients with HBV or other causes of chronic liver disease indicates that this is an acceptable therapeutic option for these patients. However, the long-term prognosis for HCV-HIV co-infected patients must remain guarded.
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