Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C: an observational cohort study

Warren‐Gash, Charlotte; Childs, Kate; Thornton, Alicia; Demma, Shirin; Srivastava, Ankur; Leen, Clifford; Agarwal, Kosh; Rodger, Alison; Sabin, Caroline; Chic, Joint Uk

doi:10.1007/s15010-016-0976-x

Cited by 8 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HIV infection complicated by HCV or HBV coinfection seems to greatly precipitate in the development of HCC due to accelerated carcinogenicity, although the real pathogenic mechanism has not been fully understood [ 41 , 42 , 43 , 44 , 45 ]. Currently, it has been clearly shown that 25% of liver death in HIV+ patients is linked to the presence of HCC [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

Guerrini

Berretta

Guaraldi

et al. 2021

Cancers

View full text Add to dashboard Cite

Background: HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV-infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. Results: Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (p = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83 p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18 p< 0.001), HCC diameter (HR 1.16 p = 0.028), and number of HCC nodules (HR 1.26 p = 0.003) were predictors of recurrence post-LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.

show abstract

Section: Discussionmentioning

confidence: 99%

Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

Guerrini

Berretta

Guaraldi

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Between alcohol abuse and antiretroviral therapy‐related toxicity, hepatitis C virus (HCV) co‐infection has been so far the major underlying cause, with a reported prevalence of 70%. 1 , 2 , 3 Liver transplantation (LT) has been demonstrated to be a feasible and effective treatment for ESLD HIV‐positive patients, even in the presence of hepatocellular carcinoma (HCC) diagnosis, reaching outcomes comparable to non‐HIV patients. 1 , 2 , 3 Nonetheless, HCV/HIV co‐infected LT recipients have been characterized by a dismal outcome, mainly due to a severe HCV recurrence on the liver allograft, that is accelerated by HIV co‐infection.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 Liver transplantation (LT) has been demonstrated to be a feasible and effective treatment for ESLD HIV‐positive patients, even in the presence of hepatocellular carcinoma (HCC) diagnosis, reaching outcomes comparable to non‐HIV patients. 1 , 2 , 3 Nonetheless, HCV/HIV co‐infected LT recipients have been characterized by a dismal outcome, mainly due to a severe HCV recurrence on the liver allograft, that is accelerated by HIV co‐infection. 4 Nowadays, direct‐acting anti‐HCV drugs (DAAs) have been effectively controlling such risk.…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of end‐stage liver disease (ESLD) in human immunodeficiency virus (HIV)‐infected patients is multifactorial. Between alcohol abuse and antiretroviral therapy‐related toxicity, hepatitis C virus (HCV) co‐infection has been so far the major underlying cause, with a reported prevalence of 70% 1‐3 . Liver transplantation (LT) has been demonstrated to be a feasible and effective treatment for ESLD HIV‐positive patients, even in the presence of hepatocellular carcinoma (HCC) diagnosis, reaching outcomes comparable to non‐HIV patients 1‐3 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

miRNA expression profiles in liver grafts of HCV and HIV/HCV‐infected recipients, 6 months after liver transplantation

Bulfoni

Pravisani

Dalla

et al. 2021

Journal of Medical Virology

View full text Add to dashboard Cite

In hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co‐infected patients, HIV enhances HCV replication and liver damage. Several microRNAs (miRNAs), active in pro‐fibrotic and inflammatory pathways, have been implicated in the pathogenesis of this phenomenon. However, these miRNAs have been tested only in explanted cirrhotic livers, when the liver damage has become chronic and irreversible. No data are available on the early phase of viral infection, such as early after liver transplantation (LT). In the present study, the expression of miR‐101, miR‐122, miR‐155, miR‐192, miR‐200c, miR‐338, and miR‐532 was determined by quantitative real‐time polymerase chain reaction in liver biopsies of HCV (n = 19) and HCV/HIV‐infected (n = 20) LT recipients, as well as in a control group (n = 18) of noninfected patients, transplanted for alcoholic cirrhosis. The timing of liver biopsy was 6 months post‐LT. None of the patients was treated with direct‐acting anti‐HCV drugs. All co‐infected recipients had suppressed HIV viral load. Grading and staging were assessed according to the Ishak Classification. HCV and HIV viral load were measured in the sera. miR‐101 (p = .03), miR‐122 (p = .012), and miR‐192 (p = .038) were significantly downregulated in HCV/HIV co‐infected and HCV mono‐infected recipients when compared with noninfected recipients, and such downregulation was more pronounced in co‐infected ones. Moreover, in co‐infected recipients but not in mono‐infected ones, miR‐101 inversely correlated with the peripheral HCV‐RNA levels (r = .41, p = .04) and miR‐122 inversely correlated with peripheral HCV‐RNA levels (r = .49, p = .03) and with the histological grading (r = .51, p = .02). In conclusion, as early as 6 months after LT, the presence of HIV‐HCV co‐infection enhanced a significant downregulation of certain miRNAs that showed a direct correlation with HCV viral load and liver inflammation.

show abstract

“…A subgroup that deserves to be highlighted is patients coinfected with hepatitis B or C. These patients have higher risks of cirrhosis progression, HCC and terminal hepatic disease than the monoinfected (9) . Historically, the coinfected patients with hepatitis C had a worse prognosis because the immunosuppression frequently resulted in infectious complications and aggressive recurrence of the virus C, which is the leading cause of death in these patients.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation in Hiv Patients: A Case Series From the Northeast Region of Brazil

Hyppolito

Castro

Girão

et al. 2022

Arq. Gastroenterol.

View full text Add to dashboard Cite

Background: The emergence of potent combined highly active antiretroviral therapy (ART) in 1996 changed the natural history of HIV infection, with a significant reduction in mortality due to opportunistic infections but increased morbidity due to chronic cardiovascular, hepatic, and renal diseases. In May 2016, a reference center for liver transplantation in the Northeast of Brazil performed the first liver transplantations (LT) in HIV patients, with five others until 2021. Methods: The criteria for selection of LT were good adherence and absence of resistance to ART, HIV viral load maximum suppression, T-CD4+ lymphocyte count of more than 100 cells/mm3, and absence of opportunistic infections in the last 6 months. Results: Six liver transplants were performed between May 2016 and May 2021, five men, with a mean age of 53.2 years, and one was a diabetic patient. All patients had access to grafts with short cold ischemia with a mean time of 5 hours and 39 minutes. The 4-month survival rate was 100%, with a range time of follow-up of 4-63 months (mean time of 31 months). The mean pre-transplant T-CD4+ lymphocyte count was 436 cells/mm3. The mean length of hospital stay after transplantation was 16.8 days. One patient presented precocious vena cava thrombosis; another had stenosis of cavocaval anastomosis leading to refractory ascites, renal failure and post-transplant graft dysfunction, and another presented stenosis of choledochal anastomosis. Immunosuppression and prophylaxis were used according to standard protocols, and there were no differences in the profile of infections or rejection after liver transplantation. Conclusion: This case series documents good survival and usual transplant procedures for confirmed HIV cases.

show abstract

Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C: an observational cohort study

Cited by 8 publications

References 17 publications

Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

miRNA expression profiles in liver grafts of HCV and HIV/HCV‐infected recipients, 6 months after liver transplantation

Liver Transplantation in Hiv Patients: A Case Series From the Northeast Region of Brazil

Contact Info

Product

Resources

About