HIV Coinfection Does Not Worsen Liver Transplant Outcomes in People with Hepatitis B or C

HIV positive liver transplant recipients with hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection did not fare worse overall than HIV negative people, according to a Spanish study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010) last month in Boston. Coinfected patients were less likely to experience organ rejection, but HCV recurrence was a leading cause of adverse outcomes.

About one-third of HIV positive individuals are estimated to be coinfected with hepatitis B or C. Coinfection has been linked to accelerated liver disease progression and poorer response to interferon-based hepatitis treatment.

Several studies conducted earlier in the HIV/AIDS epidemic showed that people with HIV had more complications and shorter survival after liver transplantation compared with their HIV negative counterparts, but much of this work was done before the development of optimally suppressive and well-tolerated combination antiretroviral therapy (ART). More recent comparisons have found that HIV positive and HIV negative patients can obtain similar outcomes.

In the present study, investigators from Hospital Ramon y Cajal in Madrid looked at complications and mortality among all 184 positive patients who received liver transplants at their center between January 2001 and May 2010 due to cirrhosis associated with viral hepatitis. Within this group, 18 people (10%) were HIV positive.

Results

"In viral cirrhotic subjects undergoing liver transplantation, HIV coinfection did not worsen outcomes within the first 5 years, although 100% of deaths (n=3) were related to HCV recurrence," the researchers concluded. "HIV patients showed lower rates of rejection and higher rates of CMV infection after liver transplantation.

Investigator affiliation: Hospital Ramon y Cajal, Madrid, Spain.

10/8/10

Reference
A Moreno, S Del Campo, R Barcena, and others. In the HAART Era, in Patients with Viral Cirrhosis Undergoing Liver Transplantation, HIV-Coinfection Does not Lead to Five-Year Reduced Survival. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010). Boston, September 12-15, 2010. Abstract V-1792.Looking only at 160 patients with HCV, complications were somewhat more common among HIV positive compared with HIV negative individuals, but only mortality was statistically significant: