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In the HAART Era, in Viral Cirrhosis Liver Transplant Candidates, HIV Co-infection Remains as an Independent Predictor of Mortality on the Waiting List with a death rate of 48% at 24 weeks), but Not after Liver Transplantation:
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Reported by Jules Levin
CROI Feb 16-19 2010 SF
A Moreno, R Barcena, S del Campo, A Muriel, J Fortun, A Martinez, J Nuno, Maria Perez-Elias*, J Casado, and S Moreno
Hosp Ramon y Cajal, Madrid, Spain
Results: Patient-distribution was the following: 252 HCV (81%), 39 HBV (13%), and 18 HBV/HCV (6%). All HIV-subjects (n = 44, 14%) were HCV (n = 36, 82%) or HCV/HBV (n = 8, 18%), none isolated HBAgs+; 75% were on HAART, and 66% had CD4 counts over 200 cells/mL. The median HIV-RNA, at inclusion on WL, was 1,7log10 copies/mL (<200 copies/mL in 75%). The rates of LT, death, or withdrawal from the list according HIV-co-infection were 36 vs 58%, 45 vs 21%, and 7 vs 15% (P =0.001). Despite similar time frames between first evaluation in the LT-Unit and inclusion in the WL (101 vs 95 days, P =0.6) and no differences in the median MELD scores at inclusion in the WL (18 excluding HCC, P =0.28), the probability of survival on WL at 90, 180 and 365 days was significantly lower among HIV subjects: 67% vs 86%, 52% vs 74%, and 41% vs 63% (P =0.001).
By multivariate analysis, independent predictors of mortality on WL were: HIV-co-infection (HR = 2.543; 95%CI 1.427 to 4.529, P =0.002), prior spontaneous bacterial peritonitis (HR = 2.145; 95%CI 1.336 to 3.444, P =0.002), and older age (HR = 1.025; 95%CI 1.000 to 1.051, P =0.048), or higher MELD scores (HR = 1.133; 95%CI 1.100 to 1.168, P =0.0001) at inclusion in the WL.
However, after a median follow-up of 91 weeks days after LT (0 to 431), HIV-co-infection did not lead to a poorer survival at 1, 3, and 5 years: 100% vs 86%; 82% vs 72%; 54% vs 65% (P =0.65). HIV-subjects showed a significantly lower rate or rejection (6% vs 33%, P =0.024), and although the rates of peg-IFN plus RBV use were similar (44% vs 41%, P =0.81), HCV-recurrence-related death was higher among HIV-subjects (3/3 (100%) vs 12/52 (23%); P =0.017)
Conclusions: In the HAART era, and despite similar management than non-HIV subjects, HIV-co-infection remains as an independent predictor of mortality on the WL, with a death rate of 48% at 24 weeks. After LT, survival in the first 5 years of follow-up was similar, although all HIV-infected patients died due to HCV recurrence.
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