[Liver transplantation in patients with HIV infection: a reality in 2004].
According to current estimates, there are 60,000 to 80,000 HIV and HCV coinfected individuals in Spain, and 5,000 to 10,000 HIV and HBV coinfected individuals. Among these patients, 10% to 15% have liver cirrhosis. Thus, end-stage liver disease is one of the major causes of death in our country. Liver transplantation is the only therapeutic option for these patients. Accumulated experience in North America and Europe in the last five years indicates that three-year survival in HIV-positive liver transplant recipients is similar to that of HIV-negative recipients. The selection criteria for HIV transplant candidates includes the following: no history of opportunistic infections, CD4 lymphocyte count higher than 100 cells/mm3, and HIV viral load suppressible with antiretroviral treatment. In Spain, where the majority of patients are former drug abusers, complete abstinence from heroin or cocaine use during two years is also required, with the possibility of the patient being in a methadone program. To date 26 hepatic transplants have been performed in the same number of patients, with only two deaths (7%) after a median follow-up of eight months (1-28). The main problems in the post-transplantation period in all the series has been recurrent HCV infection, which is the principle cause of post-transplantation mortality, and pharmacokinetic and pharmacodynamic interactions between the antiretroviral and immunosuppressive agents. There is little experience with pegylated interferon and ribavirin treatment in this population.
Miró
José M
JM
Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain. jmmiro@ub.edu
Montejo
Miguel
M
Rufí
Gabriel
G
Bárcena
Ramón
R
Vargas
Víctor
V
Rimola
Antonio
A
Bañares
Rafael
R
Valdivieso
Andrés
A
Fabregat
Jordi
J
Vicente
Eduardo de
Ed
Margarit
Carles
C
Moreno
Asunción
A
Miralles
Pilar
P
Aguirrebengoa
Koldo
K
Xiol
Francesc Xavier
FX
Fortún
Jesús
J
Pahissa
Albert
A
Laguno
Montse
M
Salcedo
Magdalena
M
Cisneros
José Miguel
JM
Quereda
Carmen
C
Tuset
Montse
M
Castón
Juan José
JJ
Torre-Cisneros
Julián
J
D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004347:Drug Interactions; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016174:Hepacivirus / Q000502:physiology; D006515:Hepatitis B virus / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000208:ethnology / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D019562:Viral Load; D014775:Virus Activation; D014850:Waiting Lists
D019380:Anti-HIV Agents; D007166:Immunosuppressive Agents