OTHER-TO-CHILD TRANSmission of human immunodeficiency virus (HIV) in sub-Saharan Africa can be decreased with use of nevirapine (NVP) and zidovudine (ZDV). 1-3 Phase 1 and 3 studies have evaluated the pharmacokinetics, safety, and efficacy of NVP among women and infants who received various ZDV regimens. 4-6 Information on the efficacy of adding neonatal ZDV to a standard regimen of NVP (the HIVNET 012 regimen of an intrapartum single 200-mg oral dose plus a single infant oral dose of 2 mg/kg 1) is limited. This information is needed because most women in sub-Saharan Africa do not receive antenatal antiretroviral treatment of ZDV or other regimens and present in labor with HIV status unknown. We hypothesized that in situations in which the mother is tested for HIV at the time of presentation for delivery, giving 2 short drug regimens to the infant at birth would be more effective in increasing viral suppression Author Affiliations are listed at the end of this article.

Background Since 2002, the Model of End Stage Liver Disease (MELD) score has been the basis of the liver transplant (LT) allocation system. Among older adult LT recipients, short-term outcomes in the MELD era were comparable to the pre-MELD era, but long-term outcomes remain unclear. Material/Methods This is a retrospective cohort study using the UNOS data on patients age ≥50 years who underwent primary LT from February 27, 2002 until October 31, 2011. Results A total of 35,686 recipients met inclusion criteria. The cohort was divided into 5-year interval age groups. Five-year over-all survival rates for ages 50–54, 55–59, 60–64, 65–69, and 70+ were 72.2%, 71.6%, 69.5%, 65.0%, and 57.5%, respectively. Five-year graft survival rates after adjusting for death as competing risk for ages 50–54, 55–59,60–64, 65–69 and 70+ were 85.8%, 87.3%, 89.6%, 89.1% and 88.9%, respectively. By Cox proportional hazard modeling, age ≥60, increasing MELD, donor age ≥60, hepatitis C, hepatocellular carcinoma (HCC), dialysis and impaired pre-transplant functional status (FS) were associated with increased 5-year mortality. Using Fine and Gray sub-proportional hazard modeling adjusted for death as competing risk, 5-year graft failure was associated with donor age ≥60, increasing MELD, hepatitis C, HCC, and impaired pre-transplant FS. Conclusions Among older LT recipients in the MELD era, long-term graft survival after adjusting for death as competing risk was improved with increasing age, while over-all survival was worse. Donor age, hepatitis C, and pre-transplant FS represent potentially modifiable risk factors that could influence long-term graft and patient survival.

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