[Liver transplantation: is it possible in HIV/HCV co-infected patients?].
The prognosis of HIV infection has been modified by antiretroviral therapy. However, the morbidity and the mortality of HCV co-infection increase and may be a major problem of health service. Up to now co-infected patients are excluded of transplantation due to complexity, the ethical aspects, the immunodeficiency and the co-infection. This study tries to estimate the feasibility in this population. Between December 1999 and March 2002, seven patients were transplanted. The average of CD4 was 332/ml; the viral load was <50 copies/ml. Before transplantation, no patient had experienced opportunist infection and all patients received antiretroviral therapy adapted to their history. The average follow-up is of 14 months: one patient died 3 months after transplantation, the other one presented a candida in oesophagus, the average of CD4 was 280/ml, and viral load was <50 copies/ml in five patients. A relapse of HVC was observed in all patients. Interferon/rivabirine therapy was proposed for four patients. Every patient received tacrolimus and corticoids. HAART were modified four times for toxicity and one time for virological failure. We observed two cases of transient renal insufficiency, two cases of diabetes, two cases of pancreatitis, and abnormalities of the respiratory mitochondrial chain in four patients. Finally, liver transplantation in HIV-HCV co-infected patients seems to be feasible when strict criteria of selection are taken into account. This still experimental strategy requires a multidisciplinary partnership.
Service des maladies infectieuses, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France. daniel.vittecoq@pbr.ap-hop-paris.fr
D
D
Vittecoq
E
E
Teicher
M
M
Merad
J Duclos
JD
Vallée
E
E
Dussaix
D
D
Samuel
D000328:Adult; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D015203:Reproducibility of Results