INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIV patients with a consequent increase in the number of HIV patients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was <50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIV patients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.
INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIVpatients with a consequent increase in the number of HIVpatients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was <50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIVpatients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.
Authors: Gregory M Lucas; Michael J Ross; Peter G Stock; Michael G Shlipak; Christina M Wyatt; Samir K Gupta; Mohamed G Atta; Kara K Wools-Kaloustian; Paul A Pham; Leslie A Bruggeman; Jeffrey L Lennox; Patricio E Ray; Robert C Kalayjian Journal: Clin Infect Dis Date: 2014-09-17 Impact factor: 9.079
Authors: Fabrizio Di Benedetto; Giuseppe Tarantino; Giorgio Ercolani; Umberto Baccarani; Roberto Montalti; Nicola De Ruvo; Massimiliano Berretta; Gian Luigi Adani; Matteo Zanello; Marcello Tavio; Nicola Cautero; Umberto Tirelli; Antonio D Pinna; Giorgio E Gerunda; Giovanni Guaraldi Journal: Oncologist Date: 2013-05-10
Authors: Giovanni Guaraldi; Giovanni Dolci; Stefano Zona; Giuseppe Tarantino; Valentina Serra; Roberto Ballarin; Erica Franceschini; Mauro Codeluppi; Thomas D Brothers; Cristina Mussini; Fabrizio Di Benedetto Journal: AIDS Res Ther Date: 2017-08-05 Impact factor: 2.250