June 10, 2009

Liver Transplant in HBV/HIV Coinfected Patients Successful

People coinfected with both the hepatitis B virus (HBV) and HIV have excellent survival rates following a liver transplant, according to a study published in the June 1 issue of AIDS.

HBV can become a chronic disease in roughly 25 percent of people who are also infected with HIV. When this occurs, people are at increased risk of liver failure and liver cancer, usually many years after first becoming infected. HBV disease, however, progresses more rapidly in coinfected people than in people not infected with HIV.

Moreover, when people develop end-stage liver disease, the only recourse is a liver transplant. For many years, people with HIV weren’t even considered viable candidates for a transplant. After it became clear that antiretroviral (ARV) therapy was significantly extending the survival of people with HIV, however, advocates successfully lobbied for coinfected people to be transplant candidates. Unfortunately, few studies have been published on the outcomes of liver transplant in coinfected people.

To determine the success of liver transplants in this population, Mariagrazia Tateo, MD, PhD, from the University of Bari, in Italy, and her colleagues examined the outcomes of transplants in 75 people living with HIV performed at the Hôpital Paul Brousse, Centre Hepato-Biliaire, in Paris. Thirteen of the patients were coinfected with HIV and HBV. Six were additionally infected with hepatitis C virus (HCV) as well as HIV and HBV. The average age of the patients was 46, and all had their HIV well controlled with ARV drugs.

People were followed, on average, for 32 months after their liver transplant. Survival over this time period was 100 percent. Ten of the HIV-positive patients had no rejection of their new livers. Three had mild to moderate rejection, which was ultimately overcome with changes to their immunosuppressive drugs used to prevent rejection.

Two HIV-positive patients had a recurrence of their HCV infection, but none had a recurrence of their HBV infection. Liver damage from the HCV recurrences, as well as damage to the energy-producing mitochondria of liver cells, was not evident in any of the HIV-positive patients studied.

“Our series thus demonstrate excellent results in terms of survival and the control of HBV replication following liver transplantation in HIV/HBV-coinfected patients,” the authors concluded.

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R. John Fisher, , 2009-06-12 11:32:39
After 27 years if having this virus, I feel somewhat at ease. It helps knowing that these transplants took and are viable. Just knowing that these transplants weren't rejected as so many anticipated, and that I could get a transplant if needed, makes me more comfortable. Knowing my liver could easily need a transplant in the future, I am at ease knowing it is a possibility. I won't be written off just becasue of HIV. I am indebted to these researchers.

R. John Fisher, , 2009-06-12 11:24:41
It is thrilling news that these transplants took even with the HIV co-infection. I feel somewhat at ease knowing that if I shouls need a transplant, studies show it to be a vialble procedure. And I won't be written of becuase of HIV.

Michael-Bruce, Philadelphia & Bucks Co, PA, 2009-06-11 12:51:01
After 25 years with HIV, testing negative for, and being vaccinated against, Hep B, 4 years ago I developed liver disease from ddi liver scarring, fatty liver from lypodystrophy, and I tested positive for Hep B. Having not exchanged body fluids in 25 years meant the Hep B was with me all along, but dormant. Mt. Sinai's liver team in NY studied 50 documented cases nationwide of 'd' drug liver scarring patients. Thier livers do not further deteriorate when the 'd' drugs are stopped.