title: Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients: a FIPSE/GESIDA prospective cohort study.
abstract: Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range = 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) = 2.9, 95% confidence interval (CI) = 1.5-5.8]. Independent factors for severe infections included a pretransplant Model for End-Stage Liver Disease (MELD) score >15 (HR = 3.5, 95% CI = 1.70-7.1), a history of AIDS-defining events before transplantation (HR = 4.0, 95% CI = 1.9-8.6), and non-tacrolimus-based immunosuppression (HR = 2.5, 95% CI = 1.3-4.8). In conclusion, the rates of severe and opportunistic infections are high in HIV/HCV-coinfected liver recipients and especially in those with a history of AIDS, a high MELD score, or non-tacrolimus-based immunosuppression.
authors: Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona.
authors: Asunción
authors: A
authors: Moreno
authors: Carlos
authors: C
authors: Cervera
authors: Jesús
authors: J
authors: Fortún
authors: Marino
authors: M
authors: Blanes
authors: Estibalitz
authors: E
authors: Montejo
authors: Manuel
authors: M
authors: Abradelo
authors: Oscar
authors: O
authors: Len
authors: Antonio
authors: A
authors: Rafecas
authors: Pilar
authors: P
authors: Martín-Davila
authors: Julián
authors: J
authors: Torre-Cisneros
authors: Magdalena
authors: M
authors: Salcedo
authors: Elisa
authors: E
authors: Cordero
authors: Ricardo
authors: R
authors: Lozano
authors: Iñaki
authors: I
authors: Pérez
authors: Antonio
authors: A
authors: Rimola
authors: José M
authors: JM
authors: Miró
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery / Q000821:virology; D008107:Liver Diseases / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality