Contrary to current practice, HIV infection should no longer be considered an absolute contraindication to liver transplantation, according to an article published in the Nov. 15, 2003 issue of The Journal of Infectious Diseases.
Results of a recent multi-center study show that survival in HIV-positive transplant recipients was similar to that found in contemporaneous age- and race-matched HIV-negative recipients. These preliminary findings provide new hope for many HIV-infected patients who might otherwise die of end-stage liver disease.
With the advent of improved combined-drug treatment, particularly highly active antiretroviral therapies (HAART) in the mid-1990s, immune system function has been improved in HIV-infected patients and survival prolonged. But the incidence of liver failure in such patients has grown, especially among those coinfected with hepatitis C or hepatitis B viruses. Liver transplantation in patients with HIV infection invariably failed in the pre-HAART era because of opportunistic infection or graft rejection. The question was: Would HAART change the prospects for organ transplantation in HIV infection?
The study, reported by Margaret V. Ragni and coworkers at the University of Pittsburgh, the University of Miami, the University of California, San Francisco, King's College, London, and the University of Minnesota, involved 24 subjects with HIV infection and end-stage liver disease (due to hepatitis C in 15 and hepatitis B in 7) who were prospectively followed after orthotopic liver transplantation. All but two had had antiretroviral therapy preoperatively, and all but one were treated postoperatively.
The results: After a mean follow-up of 17 months, the cumulative 12-month survival was 87.1 percent in the HIV-infected transplant recipients, compared with 86.6 percent among 5,225 HIV-negative transplant recipients of comparable age, race, and date of transplantation, as recorded in a national liver transplant registry. The probability of survival in the HIV-infected patients at 24 and 36 months was 72.8 percent for both intervals, compared to respective values 81.6 percent and 77.9 percent in the HIV-negative patients. Poorer survival was associated with postoperative intolerance of antiretroviral therapy, CD4 lymphocyte counts of less than 200/µl, plasma HIV RNA greater than 400 copies/ml, and hepatitis C coinfection.
In an accompanying editorial, Jay A. Fishman of Massachusetts General Hospital and Harvard Medical School commented that the study should provide an impetus to larger prospective trials to study liver transplantation in HIV-infected patients with and without hepatitis C, and with standardized approaches to immune suppression, treatment of graft rejection, and both anti-hepatitis C and HAART therapies.
The Journal of Infectious Diseases is published under the auspices of the Infectious Diseases Society of America (IDSA), based in Alexandria, Va., a professional society representing more than 7,500 physicians and scientists who specialize in infectious diseases.