Liver transplantation in patients with HIV infection.
1. Liver transplantation for human immunodeficiency virus (HIV)-positive patients with end-stage liver disease in the era of highly active retroviral therapy has proven to be an effective treatment. The concerns of HIV progression have not been borne out by the growing worldwide experience. 2. CD4 counts are stable and HIV viral load is controllable with medication following liver transplantation. 3. Hepatitis C virus (HCV) coinfection in HIV-positive recipients is universal, but the severity of recurrence does not appear to be different from that in HIV-negative patients with HCV liver disease. 4. Complex pharmacokinetic interactions between the calcineurin inhibitors used for immunosuppression along with protease inhibitors are present, but management directed at recognizing the need for monitoring levels does not appear to increase the risk of toxicity. 5. The degree of immunosuppression from iatrogenic drug therapy and HIV does not lead to increased risk of infectious complications.
Fung
John
J
Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA. fungj@ccf.org
Eghtesad
Bijan
B
Patel-Tom
Kusum
K
DeVera
Michael
M
Chapman
Holly
H
Ragni
Margaret
M
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D023241:Antiretroviral Therapy, Highly Active; D004347:Drug Interactions; D006084:Graft Rejection; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation / Q000592:standards / Q000639:trends
D007166:Immunosuppressive Agents