Liver transplantation in HIV-positive patients: the position of the Brazilian groups.
BACKGROUND
Patients infected with the human immunodeficiency virus (HIV) have generally been excluded from consideration for liver transplantation. Recent advances in the management and prognosis of these patients suggest that this policy must be reevaluated.


OBJECTIVE
To identify the current position of Brazilian transplant centers concerning liver transplantation in asymptomatic HIV-infected patients with end-stage liver disease.


METHODS
A structured questionnaire was submitted by e-mail to Brazilian groups who perform liver transplantation and were active in late 2003, according to the Brazilian Association of Organ Transplantation.


RESULTS
Of the 53 active groups, 30 e-mail addresses have been found of professionals working in 41 of these groups. Twenty-one responses (70%) were obtained. Most of the professionals (62%) reported that they do not include HIV-infected patients in waiting lists for transplants, primarily on account of the limited world experience. They also reported, however, that this issue will soon be discussed by the group. Those who accept these patients usually follow the guidelines provided by the literature: patients must fulfill the same inclusion criteria as the other patients with end-stage liver diseases, present low or undetectable HIV viral load, and a CD4 count above 250/mm3. They reported that there are 10 HIV-infected patients in waiting list and that only one patient has received a liver transplant in the country.


CONCLUSIONS
Most centers do not accept in waiting lists for liver transplantation patients with HIV infection, even asymptomatic ones. However, advances in the management of HIV-infected patients suggest that this policy must be reevaluated. In Brazil, there is practically no experience in liver transplantation in HIV-positive patients.
Brandão
Ajacio Bandeira de Mello
AB
Department of Internal Medicine, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, RS, Brazil. ajaccio@via-rs.net
Mariante-Neto
Guilherme
G
D000328:Adult; D001291:Attitude of Health Personnel; D001938:Brazil; D002648:Child; D003657:Decision Making; D015658:HIV Infections; D015276:Health Care Rationing; D019538:Health Care Surveys; D006801:Humans; D016031:Liver Transplantation; D018579:Patient Selection; D011795:Surveys and Questionnaires; D014850:Waiting Lists