The findings indicate that the development of ESLD in HIV-positive patients is associated with a high risk of early death. Speculating as to why this is the case, the authors state that "when ESLD develops in an HIV-positive individual, the already defective host defense against infection attributed to HIV may be further weakened by the immune defects associated with liver failure, resulting in a greater vulnerability of the HIV-positive candidate to infection or sepsis [an infection in the blood]." They further suggest that patients with HIV infection should be evaluated for transplant earlier in the course of their ESLD, as they appear to be at greater risk for infection, and that studies on whether prophylactic antibiotics may have a role in preventing this scenario may be warranted. They conclude: "Until then, it would seem prudent to monitor HIV-positive transplant candidates very closely for early signs of infection, inform them of the potential risk for infection, and urge them to seek medical attention at the earliest signs or symptoms of infection."

In the same issue, an accompanying editorial by Peter G. Stock, of the Department of Surgery at the University of California in San Francisco, CA notes that the study is the first documentation of a more rapid demise of HIV-patients awaiting transplant, adding that the importance of early transplant referral for these patients cannot be underestimated. The author suggests that transplant referral for HIV-positive patients may be delayed because HIV infection is still perceived by physicians as a barrier to undergoing a transplant, and these patients may therefore not be encouraged to meet the necessary transplant prerequisites in a timely manner, such as abstaining from alcohol and narcotics. In addition, the time it takes for the various specialists caring for HIV patients to coordinate a referral to a transplant center may be partially responsi
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
3-Nov-2005