End-stage liver disease
(ESLD) is a leading cause of morbidity and mortality amongst human
immunodeficiency virus (HIV)-positive individuals. Chronic hepatitis B and
hepatitis C virus (HCV) infection, drug-induced hepatotoxicity related to
combined anti-retro-viral therapy, alcohol related liver disease and
non-alcohol related fatty liver disease appear to be the leading causes.
It is
therefore, anticipated that more HIV-positive patients with ESLD will present
as potential transplant candidates. HIV infection is no longer a
contraindication to liver transplantation. Key transplantation outcomes such as
rejection and infection rates as well as medium term graft and patient survival
match those seen in the non-HIV infected patients in the absence of co-existing
HCV infection. HIV disease does not seem to be negatively impacted by
transplantation.
However, HIV-HCV co-infection transplant outcomes remain
suboptimal due to recurrence. In this article, we review the key challenges
faced by this patient cohort in the pre- and post-transplant period.
Below: Causes of death amongst human immunodeficiency virus-positive patients. Adapted from Smith et al[5]. AIDS: Acquired immunodeficiency syndrome; CVD: Cardio-vascular disease.
Full article at:
By:
Deepak Joshi,
Kosh Agarwal, Institute of Liver Studies, King’s College Hospital NHS
Foundation Trust, Denmark Hill, SE5 9RS London, United Kingdom
Author contributions: Joshi D and Agarwal K reviewed the
literature and wrote the manuscript.
Correspondence to: Dr. Deepak Joshi, Institute of Liver
Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS
London, United Kingdom. ten.shn@ihsoj.d
Telephone: +44-203-2999000
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