[Liver transplantation: is it possible in HIV/HCV co-infected patients?]

Area of Science:

• Hepatology
• Infectious Diseases
• Transplantation Medicine

Background:

• Hepatitis C virus (HCV) co-infection significantly increases morbidity and mortality in patients with human immunodeficiency virus (HIV).
• Liver transplantation is typically contraindicated in HIV-HCV co-infected patients due to concerns about immunodeficiency, co-infection, and ethical considerations.

Purpose of the Study:

• To evaluate the feasibility of liver transplantation in patients co-infected with HIV and HCV.
• To assess the outcomes and complications associated with liver transplantation in this specific patient population.

Main Methods:

• A cohort of seven HIV-HCV co-infected patients underwent liver transplantation between December 1999 and March 2002.
• Patients were selected based on strict criteria, including adequate CD4 counts and undetectable viral loads, and received optimized antiretroviral therapy.
• Follow-up averaged 14 months, with monitoring for opportunistic infections, viral loads, and post-transplant complications.

Main Results:

• One patient died within 3 months post-transplantation; another experienced esophageal candidiasis.
• HCV recurrence was observed in all patients, with four undergoing interferon/ribavirin therapy.
• Common complications included transient renal insufficiency, diabetes, pancreatitis, and mitochondrial chain abnormalities. Highly active antiretroviral therapy (HAART) required modifications due to toxicity or virologic failure.

Conclusions:

• Liver transplantation in carefully selected HIV-HCV co-infected patients appears feasible.
• This experimental strategy necessitates stringent patient selection and a collaborative, multidisciplinary approach to manage complex post-transplant care.