Liver transplantation for HIV/hepatitis C virus co‐infected patients

Abstract

Since the introduction of antiretroviral therapy (ART) in the mid‐1990s, AIDS‐related death has been dramatically reduced, and hepatitis‐C‐virus (HCV)‐related liver failure or hepatocellular carcinoma has currently become the leading cause of death in HIV/HCV co‐infected patients. Liver transplantation may be one of the treatments of choices in such cases, but the indications for transplantation, perioperative management including both HIV and HCV treatments, immunosuppression and the prevention/treatment of infectious complications are all still topics of debate. With the improved understanding of the viral behaviors of both HIV and HCV and the development of novel strategies, especially to avoid drug interactions between ART and immunosuppression, liver transplantation has become a realistic treatment for HIV/HCV co‐infected patients.

Living donor domino liver transplantation in a hepatitis C virus/human immunodeficiency virus-coinfected hemophilia patient: a case report

“…Liver cirrhosis due to HCV/HIV-coinfection is a remarkable indication for LT. In addition, HCV/HIV-coinfected patients affected by portal hypertension when cirrhosis is absent may be considered for LT as well [13][14][15]. In the ART era, LT for HIV-infected patients with liver disease not related with HCV had an excellent outcome [16,17].…”

Relationship between various hepatic function scores and the formation of esophageal varices in patients with HIV/hepatitis C virus co‐infection due to contaminated blood products for hemophilia

“…In fact, this serious problem has spread not only in Japan but all over the world . In such cases, liver transplantation (LT) is the only treatment option to achieve long‐term survival . It is important to note that these patients usually develop end‐stage liver cirrhosis at a young age, such as in their 30s and 40s.…”

“…Patients with HIV/HCV co‐infection classified as CP A have a 5‐year survival rate as poor as approximately 50%. Therefore, it is difficult to accurately reflect the liver reserve capacity of patients with HIV/HCV co‐infection using the CP classification …”

Aspartate transaminase–platelet ratio and Fibrosis‐4 indices as effective markers for monitoring esophageal varices in HIV/hepatitis C virus co‐infected patients due to contaminated blood products for hemophilia

“…In fact, more than 90% of the hemophiliacs in Japan who are infected with HIV also have HCV. 1,2 After the introduction of antiretroviral therapy in the late 1990s, the survival of HIV-infected patients improved dramatically because the rate of opportunistic infections related to AIDS decreased; however, the mortality due to HCV-related liver disease has not sufficiently declined in HIV/HCV co-infected patients, and thus liver-related disease has become the main cause of death in this patient group, [3][4][5][6][7] especially due to contaminated blood products. 2 It is well documented that in HIV/HCV co-infected patients, non-cirrhotic portal hypertension (NCPH) is one of the specific findings that may be related to the antiviral drug didanosine.…”