title: Spontaneous clearance of HCV in HIV-hepatitis C virus coinfected liver transplant patients: prospective study.
abstract: BACKGROUND
  Hepatitis C virus (HCV) clearance is an independent predictive factor for long-term survival in HIV-HCV liver transplantation patients. After 46 months of antiviral therapy it is achieved in up to 80% of cases. Little is known, however, about spontaneous viral clearance. We performed prospective study of HIV-HCV coinfected liver transplant patients.
  
  
  METHODS
  Between January 1, 2001, and December 31, 2011, we analyzed the parameters from among HIV-HCV coinfected liver transplant patients of donor and recipient ages, transplant cause, Model for End-Stage Liver Disease (MELD) score, donor and recipient serology, transplant date, viral load before and after transplantation, immunosuppressive therapy, HCV recurrence, HCV viral clearance (spontaneous and duration), retransplant cause, and viral load before and after retransplant, as well as survival.
  
  
  RESULTS
  The seven transplanted HIV-HCV coinfected patients had most commonly HCV-related hepatocarcinoma (n = 5, 71.42%). Three subjects (42.85%) developed HCV recurrences. Two patients (28.57%) were retransplanted, both due to HCV recurrence with one of them developing a spontaneous clearance of HCV (14.28%). This patient showed a preoperative HIV viral load < 50 copies IU/mL, CD4+ count 486/μL, HCV-RNA 2564 IU copies/mL, Anti-HBc+, and MELD 30. The donor was an 81-year-old female who was Anti-HBc+. Immunosuppressive therapy consisted of cyclosporine, mycophenolate, and prednisone. One month after transplantation, the patient developed an acute cellular rejection episode with progression of liver disease secondary to the HCV recurrence (56.5 × 105 copies IU/mL). He started antiviral treatment (α-interferon and ribavirin), but due to side effects and interactions with the antiretrovirals, they were stopped after four doses. The viral load decreased spontaneously and progressively until it became negative at 146 days after transplantation; he was retransplanted and HCV-RNA has continued to be negative after 772 days.
  
  
  CONCLUSIONS
  Spontaneous clearance of HCV among HIV-HCV coinfected liver transplant patients is possible. Despite no treatment, one patient still has no detectable HCV viral load after retransplantation.
authors.affiliation: Department of General and Digestive System Surgery, Virgen del Rocio University Hospital, Seville, Spain. dra_gutierrez_moreno@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Gutiérrez-Moreno
authors.forename: C
authors.initials: C
authors.lastname: Bernal-Bellido
authors.forename: G
authors.initials: G
authors.lastname: Suárez-Artacho
authors.forename: J M
authors.initials: JM
authors.lastname: Alamo-Martínez
authors.forename: L M
authors.initials: LM
authors.lastname: Marín-Gómez
authors.forename: J
authors.initials: J
authors.lastname: Serrano-Díaz-Canedo
authors.forename: F J
authors.initials: FJ
authors.lastname: Padillo-Ruiz
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez-Bravo
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications / Q000601:surgery*; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000150:complications / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D007166:Immunosuppressive Agents