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Easl 2009: Liver Transplant Equally Successful in HIV-Positive and HIV-Negative Patients

Similar survival rates after liver transplantation were found in both HIV–positive and HIV–negative patients, according to results from a long–term study presented here at the European Association for the Study of the Liver 44th Annual Meeting, suggesting a good prognosis for HIV–infected patients after transplantation.

John O’Grady, MD, FRCPI, consultant hepatologist, and colleagues from the Institute of Liver Studies, King’s College Hospital, London, United Kingdom, explained that these results were from one of the first studies to provide all–important long–term outcomes in HIV–positive patients. The results reinforce the idea that HIV–positive patients are suitable candidates for liver transplantation and should have similar access to treatment.

“Central to our findings is the message that if you are HIV–positive and have any indication for liver transplantation other than hepatitis C virus [HCV], then the results are exceptionally good over the long term. There are also no differences observed from patients who are not HIV infected, ” Dr. O’Grady told Medscape Gastroenterology.

At 1 and 5 years of follow–up, the results showed no difference in survival rates between HIV–positive and HIV–negative patients (86.5% and 74% vs 87.1% and 78%, respectively, P = .843). However, the study confirmed that patients coinfected with HCV did less well.

“In the HCV patients, there is a problem with both intermediate and long–term results. This is linked to the aggressive return of HCV in the new, transplanted liver. Historically, there has been significant disagreement over whether to transplant in HCV patients, but more recently we understand that the challenge now is to start trying to improve control of HCV recurrence in transplant patients, ” said Dr. O’Grady.

New antiviral therapies for HCV may improve outcomes and tolerance in liver–transplant patients. An extensive ongoing National Institutes of Health trial will eventually provide results on liver transplantation in HCV/HIV–coinfected patients. Based on current evidence, Dr. O’Grady suggested that transplant surgeons proceed with caution.

“In these patients, you have to deal with the issue that there are more problems in HIV patients with HCV. We certainly don’t want to stop transplants, but we need to address this in different ways,” Dr. O’Grady pointed out. “For example, we may soon have new drugs, which will turn this around. ”

Didier Samuel MD, PhD, professor of hepatology at Assistance Publique–Hôpitaux de Paris Hôpital Paul Brousse in France, confirmed that liver transplants in HIV–positive patients show no evidence of HIV–disease progression posttransplant.“HIV should be controlled before transplantation. Indeed, results of liver transplants of [hepatitis B]–coinfected patients are excellent due to treatment with anti–HBs immunoglobulin, and excellent antivirals effective against HIV and [hepatitis B],” he told Medscape Gastroenterology.

However, Dr. Samuel emphasized that HCV was a large problem in this group of people. Thirty percent of HIV patients are coinfected with HCV, so this is a major cause of liver disease in these patients. The progression of liver disease in HIV–infected patients is also more severe than in HIV–negative patients, and there is often a need for transplant.

“Results are improving, but survival after transplant of HCV/HIV patients is still lower. However, results are improving, and with antiviral treatments improving in coming years, there is every reason to be positive,” Dr. Samuel said.

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Source: Medscape




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