Intention‐to‐treat survival analysis of hepatitis C virus/human immunodeficiency virus coinfected liver transplant: Is it the waiting list?

Abstract

In human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the accelerated severity of liver disease, associated comorbidities, and mortality on the waiting list could change the possibility and results of liver transplantation (LT). Intention-to-treat survival analysis (ITTA) can accurately estimate the applicability and efficacy of LT. The primary objective of this study was to compare the survival of patients with HCV with and without HIV infection. We analyzed a cohort of 199 patients with HCV infection enrolled for LT between 1998 and 2015; 17 were also infected with HIV. The patients with HCV/HIV coinfection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%; P < 0.001). ITTA at 1, 3, and 4 years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV coinfection, respectively (Wilcoxon test P < 0.05). The ITTA at 1, 3, 6, and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV coinfection, respectively (log-rank P < 0.05; Wilcoxon test P < 0.01). A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age > 70 years (hazard ratio [HR] 5 3.12; P < 0.05), United Network for Organ Sharing status 1 (HR 5 10.1; P < 0.01), Model for End-Stage Liver Disease (HR 5 1.13; P < 0.001), and HIV coinfection (HR 5 2.65; P < 0.05) had independent negative predictive value for survival. In conclusion, our study indicates that HIV coinfection is a factor in mortality prior to transplantation and associated with higher mortality on the waiting list.

Successful Pre- and Posttransplant Sofosbuvir-Based Anti-Hepatitis C Virus Treatment in Persons Living With Human Immunodeficiency Virus Infection

“…Pre-OLT treatment should be strongly considered for HIV-infected patients because of the higher wait-list mortality due to progression of liver disease [2]; nevertheless, treatment could be delayed posttransplant in patients with HCC and compensated liver disease.…”

“…Human immunodeficiency virus (HIV)/HCV-coinfected patients with decompensated cirrhosis have lower survival rates (less than 1 year), mainly because of higher mortality while on the list [2]. A meta-analysis of all the reported series demonstrated that in HCV/HIV-coinfected persons, survival at 5 years is 50%–55%, which is poorer than in HCV-monoinfected patients, mainly due to the more aggressive recurrence of HCV and consequent graft loss and death [1].…”

Use of Hepatitis C-Positive Donor Livers in Liver Transplantation

“…This has brought attention to liver transplantation in HIV/HCV co-infected patients, who have higher mortality rates in comparison to HCV mono-infected patients. 26 In fact, patient and graft survival following LT in HIV/HCV co-infected patients has been found to be worse in comparison to HCV mono-infected patients. 27 …”

Il trattamento DAA nei pazienti con infezione da HCV/HIV in lista di attesa per il trapianto di fegato

“…Il tasso di sopravvivenza a 1 anno di questa casistica è stato del 100%. I pazienti con co-infezione da HIV/HCV con cirrosi hanno una maggior rischio di scompenso e di mortalità per causa epatica (1). Da circa 15 anni il trapianto di fegato è per loro un' opzione terapeutica possibile, pur nella consapevolezza che la sopravvivenza post trapianto rimane ridotta rispetto alla popolazione mono-infetta, e nella casistiche pubblicate la sopravvivenza a 5 anni dal trapianto non supera il 50-55%.…”