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Survival of Liver Transplant Patients Coinfected with HIV and HCV Is Adversely Impacted by Recurrent Hepatitis C
Author(s) -
De Vera M. E.,
Dvorchik I.,
Tom K.,
Eghtesad B.,
Thai N.,
Shakil O.,
Marcos A.,
Demetris A.,
Jain A.,
Fung J. J.,
Ragni M. V.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01546.x
Subject(s) - medicine , hepatitis c , human immunodeficiency virus (hiv) , liver transplantation , virology , hepatitis c virus , immunology , transplantation , virus
Although liver transplantation (LTx) in HIV‐positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV‐positive patients who underwent LTx. HIV infection was well controlled posttransplantation. Survival in HIV‐positive/HCV‐positive patients was shorter compared to a cohort of HIV‐negative/HCV‐positive patients matched in age, model for end‐stage liver disease (MELD) score, and time of transplant, with cumulative 1‐, 3‐ and 5‐year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV‐related complication in coinfected subjects (RR = 2.6, 95%CI, 1.06–6.35; p = 0.03). Risk factors for poor survival included African‐American race (p = 0.02), MELD score >20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA >30 000 000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon‐α/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.