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HIV positive and HIV negative patients have comparable survival rates following liver transplant, according to new research presented today at EASL 2009, the annual meeting of the European Association for the Study of Liver in Copenhagen, Denmark.
The study results showed no difference in survival rates at 1 and 5 years between HIV negative and HIV positive patients (86.5 percent and 74 percent versus 87.1 percent and 78 percent, p=0.843), suggesting a good prognosis for HIV positive patients following liver transplant. However, the study confirmed that co-infection with hepatitis C virus (HCV) is a significant predictor of poorer survival rates in patients with HIV. Survival rates at 1 and 5 years were 73 percent and 53 percent in HIV positive patients with hepatitis C versus 87 percent and 69 percent (p=0.047) in HIV negative patients with hepatitis C.
Kosh Agarwal, of the Institute of Liver Studies, KingsCollegeHospital, London, who led the study, said: "Data on long term outcomes from liver transplantation in HIV patients is limited. These study results are valuable confirmation that selected HIV positive patients are as suitable candidates for liver transplant as HIV negative patients and should have similar access to treatment. However, those patients with co-infection with hepatitis C did less well, emphasizing the need for appropriate antiviral therapy early in the course of their HCV related liver disease. In the context of co-infection, these data emphasize the need to develop newer and more innovative treatment strategies. These should include exposure to new small molecule therapies for HCV that are currently being explored in mono-infection."
The researchers conducted a prospective analysis of the UK Transplant Database to determine the long-term outcomes in HIV patients undergoing liver transplant in the UK. They examined 6,315 adult patients (>18 years) undergoing their first liver transplant between March 1994 and April 2008. The patient groups compared in this analysis included:
HIV positive patients who tested negative for both hepatitis C and hepatitis B
HIV negative patients with hepatitis C
HIV positive patients with hepatitis C
The three patient groups were comparable according to the Model End Stage Liver Disease (MELD) scores, which is a numerical scale to score disease severity and improve organ allocation in transplantation. HIV positive patients were younger compared to HIV negative patients (mean 42.2 years versus 51.2, p=0.001) and HIV positive patients co-infected with hepatitis C were younger (mean 39.9 years versus 51.8; p=0.0001) than HIV negative patients with hepatitis C.