Survival
and Recurrence of Hepatitis C after Liver Transplantation in HIV-HCV Coinfected
Patients
As
people with HIV live longer due to effective
antiretroviral therapy, liver
disease related to chronic hepatitis
C virus (HCV) infection has become a leading cause of illness and death. The
only treatment for end-stage liver disease is liver
transplantation.
As reported in the February 2008 issue of Hepatology,
French researchers compared the survival and severity of recurrent HCV
infection after liver transplantation among HIV-HCV
coinfected and HCV monoinfected recipients. The analysis included all 79 patients
who received a first liver graft due to HCV-related liver disease at a single
medical center between 1999 and 2005.
Within this group, 35 were coinfected
patients on HAART with well-controlled
HIV. On average, the coinfected patients were younger (43 vs 55 years) and had
a higher Model for End-Stage Liver Disease (MELD) score (18.8 vs 14.8) compared
with the HCV monoinfected subjects.
Results
•
The survival rate at 2 years was 73% for the HIV-HCV coinfected patients, compared
with 91% for the monoinfected patients.
•
The 5-year survival rates were 51% and 81%, respectively.
•
In a multivariate analysis, MELD score was the only factor significantly associated
with survival.
•
Using the Kaplan-Meier method, the likelihood of progression to fibrosis stage
F2 or higher was significantly greater in the coinfected group (P < 0.0001).
Conclusion
"The
results of liver transplantation in HIV-HCV coinfected patients were satisfactory
in terms of survival benefit," the authors concluded.
However, they
added, "Earlier referral of these patients to a liver transplant unit, the
use of new drugs effective against HCV, and an avoidance of drug toxicity are
mandatory if we are to improve the results of this challenging indication for
liver transplantation."
3/07/08
Reference
JC
Duclos-Vallee, C Feray, M Sebagh, and others. Survival and recurrence of hepatitis
C after liver transplantation in patients coinfected with human immunodeficiency
virus and hepatitis C virus. Hepatology 47(2): 407-417. February 2008.
