Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus co‐infection: update in 2013

Abstract

Because of the progress of anti-retroviral therapy (ART) for human immunodeficiency virus (HIV), mortality due to opportunistic infection resulting in AIDS has been remarkably reduced. However, meanwhile, half of those patients have died of end-stage liver cirrhosis due to hepatitis C virus (HCV) with liver cirrhosis and early occurrence of hepatocellular carcinoma. Recently, in 2013, noncirrhotic portal hypertension due to ART drugs or still unknown mechanisms have become problematic with early progression of the disease in this patient population. Liver transplantation (LT) could be one treatment of choice in such cases, but the indications for LT perioperative management, including both HIV and HCV treatments and immunosuppression, are still challenging. In this review, we update the literature on HIV/HCV co-infection and LT as well as recent effort for modifying allocation system for those patients.

Effects of Combined Alcohol and Anti‐HIV Drugs on Cellular Stress Responses in Primary Hepatocytes and Hepatic Stellate and Kupffer Cells

“…However, there are reports indicating that antivirals singly or in combination increase the risk of comorbidities, including cardiovascular and cerebrovascular disease, pulmonary disease, bone disease, and even cancer, which undermine quality of life for those infected with HIV (Doherty et al., ; Gardner et al., ; Margolis et al., ). In the liver, non‐HIV liver disease has emerged as the most common non‐AIDS‐related cause of death among HIV‐infected patients, accounting for 15% of all deaths (Amacher and Chalasani, ; Eguchi et al., ; Price and Thio, ; Sherman et al., ). To be worse, nearly half of the HIV‐infected patients consume or abuse alcohol, which not only impairs patients' adherence to HAART but also deteriorates HIV drug‐induced hepatotoxicity leading to greater morbidity and mortality (Braithwaite et al., ,b; Hendershot et al., ).…”