HCV recurrence in HIV-infected patients after liver transplant.
Patients coinfected with hepatitis C virus (HCV) and HIV undergoing liver transplantation (LT) are at risk of early, aggressive HCV recurrence. This study investigates the use of frequent protocol-driven biopsies to identify HCV recurrence post LT in coinfected patients. Five consecutive HIV/HCV-coinfected patients underwent LT. Liver biopsies were obtained post LT at 1 hour; days 7, 120, and 365; then annually; and as clinically indicated. Stage 2 (Ishak) or higher fibrosis occurred in 4 of the 5 patients by 60, 120, 270, and 365 days. Two patients died of HCV recurrence and liver failure at 6 and 35 months post LT. Three patients survived more than 4 years after LT, 2 having sustained virologic responses to anti-HCV treatment. Another has histologic recurrence not responding to treatment. Hepatitis C virus recurrence can be rapid and aggressive after LT in HIV-coinfected patients. Serial biopsies identify recurrence early, allowing for prompt initiation of treatment.
Hughes
Christopher B
CB
Department of Surgery, Emory University School of Medicine, 101 Woodruff Circle, WMB 5034, Atlanta, GA 30322, USA. Christopher.hughes@emoryhealthcare.org
Dickson
Rolland C
RC
Krishna
Murli
M
Willingham
Darrin L
DL
Satyanarayana
Raj
R
Harnois
Denise M
DM
Keaveny
Andrew P
AP
Rosser
Barry
B
Aranda-Michel
Jaime
J
Kramer
David J
DJ
Hellinger
Walter
W
Mendez
Julio
J
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D017093:Liver Failure / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis
D000998:Antiviral Agents