title: Immunologic Predictors of Liver Transplantation Outcomes in HIV-HCV Co-Infected Persons.
abstract: Liver disease is a leading cause of mortality among HIV-infected persons in the highly active anti-retroviral therapy (HAART) era. Hepatitis C Virus (HCV) co-infection is prevalent in, and worsened by HIV; consequently many co-infected persons require liver transplantation (LT). Despite the need, post-LT outcomes are poor in co-infection. We examined predictors of outcomes post-LT. Immunologic biomarkers of immune activation, microbial translocation, and Th1/Th2 skewing were measured pre-LT in participants enrolled in a cohort of HIV infected persons requiring solid organ transplant (HIVTR). Predictive biomarkers were analyzed in Cox-proportional hazards models; multivariate models included known predictors of outcome and biomarkers from univariate analyses. Sixty-nine HIV-HCV co-infected persons with available pre-LT samples were tested: median (IQR) CD4+ T-cell count was 286 (210-429) cells mm-3; 6 (9%) had detectable HIV RNA. Median (IQR) follow-up was 2.1 (0.7-4.0) years, 29 (42%) people died, 35 (51%) had graft loss, 22 (32%) were treated for acute rejection, and 14 (20%) had severe recurrent HCV. In multivariate models, sCD14 levels were significantly lower in persons with graft loss post-LT (HR 0.10 [95%CI 0.02-0.68]). IL-10 levels were higher in persons with rejection (HR 2.10 [95%CI 1.01-4.34]). No markers predicted severe recurrent HCV. Monocyte activation pre-LT may be mechanistically linked to graft health in HIV-HCV co-infection.
authors: Department of Medicine, Johns Hopkins University, Baltimore, MD, 21205, United States of America.
authors: Ashwin
authors: A
authors: Balagopal
authors: The EMMES Corporation, Rockville, MD, 20850, United States of America.
authors: Burc
authors: B
authors: Barin
authors: Department of Medicine, Johns Hopkins University, Baltimore, MD, 21205, United States of America.
authors: Jeffrey
authors: J
authors: Quinn
authors: Department of Surgery, University of California San Francisco (UCSF), San Francisco, CA, 94122, United States of America.
authors: Rodney
authors: R
authors: Rogers
authors: Department of Medicine, Johns Hopkins University, Baltimore, MD, 21205, United States of America.
authors: Mark S
authors: MS
authors: Sulkowski
authors: Department of Surgery, University of California San Francisco (UCSF), San Francisco, CA, 94122, United States of America.
authors: Peter G
authors: PG
authors: Stock
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D060085:Coinfection / Q000150:complications / Q000276:immunology* / Q000601:surgery / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000276:immunology* / Q000601:surgery / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D016174:Hepacivirus / Q000276:immunology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000276:immunology* / Q000601:surgery / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers