Nonviral liver disease is the leading indication for liver transplant in the United States in persons living with human immunodeficiency virus

Campos‐Varela, Isabel; Dodge, Jennifer L.; Terrault, Norah A.; Brandman, Danielle; Price, Jennifer

doi:10.1111/ajt.16569

Cited by 19 publications

(22 citation statements)

References 34 publications

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“…After the wider use of DAAs, the outcomes in patients with coinfection have become similar to the other two groups. Two recent papers reported that HCV/HIV coinfected LT‐recipient outcomes have significantly improved, and HCV coinfection was not associated with graft failure among HIV infected LT recipients in post‐DAA era 28,29 . Our study showed same results after control for characteristic differences between the era and also compared by both each viral infectious status and each era.…”

Section: Discussionsupporting

confidence: 77%

“…Two recent papers reported that HCV/HIV coinfected LT-recipient outcomes have significantly improved, and HCV coinfection was not associated with graft failure among HIV infected LT recipients in post-DAA era. 28,29 Our study showed same results after control for characteristic differences between the era and also compared by both each viral infectious status and each era. Cotter et al compared the risks for graft failure after LT by Cox regression model using OPTN/UNOS file according to the infectious status in pre-and post-DAA era, separately.…”

Section: Ta B L Esupporting

confidence: 65%

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Improvements in liver transplant outcomes in patients with HCV/HIV coinfection after the introduction of direct‐acting antiviral therapies

Shimada

Ivanics

Kitajima

et al. 2022

Transplant Infectious Dis

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Background:In recipients with HCV/HIV coinfection, the impact that the wider use of direct-acting antivirals (DAAs) has had on post-liver transplant (LT) outcomes has not been evaluated. We investigated the impact of DAAs introduction on post-LT outcome in patients with HCV/HIV coinfection. Methods: Using Organ Procurement and Transplant Network/United Network for Organ Sharing data, we compared post-LT outcomes in patients with HCV and/or HIV pre-and post-DAAs introduction. We categorized these patients into two eras: pre-DAA (2008-2012 [pre-DAA era]) and post-DAA (2014-2019 [post-DAA era]). To study the impact of DAAs introduction, inverse probability of treatment weighting was used to adjust patient characteristics. Results: A total of 17 215 LT recipients were eligible for this study (HCV/HIV [n = 160]; HIV mono-infection [n = 188]; HCV mono-infection [n = 16 867]). HCV/HIV coinfection and HCV mono-infection had a significantly lower hazard of 1-and 3-year graft loss post-DAA, compared pre-DAA (1-year: adjusted hazard ratio [aHR] 0.29, 95% confidence interval (CI) 0.16-0.53 in HIV/HCV, aHR 0.58, 95% CI 0.54-0.63, respectively;3-year: aHR 0.30, 95% CI 0.14-0.61, aHR 0.64, 95% CI 0.58-0.70, respectively). The hazards of 1-and 3-year graft loss post-DAA in HIV mono-infection were comparable to those in pre-DAA. HCV/HIV coinfection had significantly lower patient mortality post-DAA, compared to pre-DAA (1-year: aHR 0.30, 95% CI 0.17-0.55; 3-year: aHR 0.31, 95% CI 0.15-0.63). Conclusions:Post-LT outcomes in patients with coinfection significantly improved and became comparable to those with HCV mono-infection after introducing DAA therapy.The introduction of DAAs supports the use of LT in the setting of HCV/HIV coinfection.

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Section: Discussionsupporting

confidence: 77%

Section: Ta B L Esupporting

confidence: 65%

Improvements in liver transplant outcomes in patients with HCV/HIV coinfection after the introduction of direct‐acting antiviral therapies

Shimada

Ivanics

Kitajima

et al. 2022

Transplant Infectious Dis

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“…Over time, the authors also show steady improvement in outcomes for liver transplant recipients with HIV, irrespective of HCV status: 3‐year patient survival and graft survival are converging between PWH (78%; 73%) and HIV‐uninfected (85%; 82%) liver transplant recipients 4 . Considering the 3‐year survival of 60% in earlier studies, this is remarkable.…”

mentioning

confidence: 77%

“…Over time, the authors also show steady improvement in outcomes for liver transplant recipients with HIV, irrespective of HCV status: 3-year patient survival and graft survival are converging between PWH (78%; 73%) and HIV-uninfected (85%; 82%) liver transplant recipients. 4 Considering the 3-year survival of 60% in earlier studies, this is remarkable. Numerically lower survival in PWH may be attributable to causes such as cancer or cardiovascular disease; reassuringly, a subanalysis of recipients after 2014 showed that 3-year survival differences were attenuated (81.2%; 86.4%, p = .34).…”

mentioning

confidence: 91%

“…3 Reflecting these advances, in this issue of the Journal, Campos-Varela and colleagues present a US registry analysis demonstrating major changes in the landscape and outcomes of liver transplantation in PWH. 4 First, they show HCV is no longer the primary indication for liver transplantation for PWH; in 2017, it was surpassed by nonviral causes, predominantly nonalcoholic steatohepatitis and alcoholic liver disease. This shift signifies the tremendous impact of DAAs, a clear success in the care of PWH and liver disease.…”

mentioning

confidence: 99%

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Clearing the hepatitis hurdle: Obstacles and opportunities in liver transplantation for people with HIV

Werbel

Durand

2021

American Journal of Transplantation

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The early experience of liver transplantation for people with HIV (PWH) was plagued by three issues: hepatitis C virus (HCV), interactions with HIV antiretroviral therapy, and organ rejection. In the first multicenter trials in the United States and Spain, liver recipients with HIV-HCV coinfection had 3-year patient and graft survival around 60%, and acute rejection rates around 40%, significantly worse than in recipients with HCV mono-infection. 1,2 These findings generated concern. Without effective antivirals for HCV, some transplant programs stopped performing liver transplants in PWH. Thus, the hurdle of HCV coinfection was a major barrier to liver transplantation for PWH.

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Cancer screening in people living with HIV

Masiá,

Gutiérrez‐Ortiz de la Tabla,

Gutiérrez

2023

Cancer Medicine

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BackgroundCancer is the leading cause of mortality in people living with HIV (PWH) and is expected to account for a growing fraction of deaths as PWH age.MethodsIn this literature review, we have compiled the most recent developments in cancer screening and screening performance in PWH, which are currently primarily implemented in well‐resourced settings. This includes an assessment of the associated benefits, harms, and cost‐effectiveness. The article also addresses unmet needs and potential strategies for tailored screening in the HIV population.FindingsIncidence and mortality due to screenable cancer are higher in PWH than in the general population, and diagnosis is frequently made at younger ages and/or at more advanced stages, the latter amenable to improved screening. Adequate evidence on the benefits of screening is lacking for most cancers in the HIV population, in whom standard practice may be suboptimal. While cancer surveillance has helped reduce mortality in the general population, and interest in risk‐based strategies is growing, implementation of screening programs in the HIV care settings remains low.InterpretationGiven the devastating consequences of a late diagnosis, enhancing early detection of cancer is essential for improving patient outcomes. There is an urgent need to extend the investigation in cancer screening performance to PWH, evaluating whether personalized measures according to individual risk could result in higher efficiency and improve patient outcomes.

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Nonviral liver disease is the leading indication for liver transplant in the United States in persons living with human immunodeficiency virus

Cited by 19 publications

References 34 publications

Improvements in liver transplant outcomes in patients with HCV/HIV coinfection after the introduction of direct‐acting antiviral therapies

Improvements in liver transplant outcomes in patients with HCV/HIV coinfection after the introduction of direct‐acting antiviral therapies

Clearing the hepatitis hurdle: Obstacles and opportunities in liver transplantation for people with HIV

Cancer screening in people living with HIV

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