Tareq Salahuddin. Creative Commons licence.
Survival after a liver transplant has improved significantly in people with HIV and hepatitis C co-infection since the introduction of direct-acting antiviral treatment for hepatitis C, US researchers report in the journal Transplantation Direct.
Due to faster progression of liver damage in people co-infected with HIV and hepatitis C, people with both viruses are especially likely to develop end-stage liver disease and require a liver transplant. Prior to the introduction of direct-acting antiviral (DAA) therapy from 2013, people with HIV had worse outcomes after liver transplantation, irrespective of hepatitis C co-infection.
Review of US liver transplant records showed that between 2008 and 2019, 64,860 liver transplants were carried out in people with a known HIV status. In the pre-DAA period, 24,238 transplants took place, 68 in co-infected people and 49 in people with HIV alone. Transplant recipients with HIV were younger and had shorter waitlist times than other recipients, while all transplant recipients without hepatitis C had higher MELD scores, indicating more severe liver damage, and were more likely to be on life support at the time of transplantation.
People with HIV and hepatitis had a significantly higher risk of graft failure (hazard ratio 1.85, 95% CI 1.31-2.59) in the pre-DAA era compared to people without either virus. This difference in risk disappeared in the DAA era, so that by three years after transplant, 81% of recipients with HIV and hepatitis C remained alive and had not suffered rejection of the donor organ (graft failure), compared with 58% in the pre-DAA era (p = 0.006). Survival was 100% over a median follow-up period of 656 days among graft recipients with HIV who had chronic hepatitis C at the time of transplant.
Three-year graft survival in people who were not co-infected with HIV and hepatitis C was similar; 80% of people with HIV alone, 83% of people with hepatitis C alone and 84% of people with neither virus remained alive without rejection of the donor organ.
Overall survival did not differ either; 84% of people with HIV and hepatitis C remained alive after three years, compared to 81% in people with HIV alone, 84% in people with hepatitis C alone and 86% in people without either virus.
Survival in the 46 recipients of livers from HIV-positive donors did not differ from the overall survival; 82% of people with HIV who received a graft from an HIV-positive donor remained alive without rejection of the donor organ after three years.
The study investigators say that their findings should encourage greater referral of people with HIV with end-stage liver disease for liver transplant assessment. They also encourage liver specialists to make use of the 2013 HOPE Act, which authorised the use of organs from HIV-positive donors for transplants to people living with HIV, to improve access to donor organs.
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