Liver transplants can be successful in HIV patients with H...( cent) were wait-listed 10 (28 percent)...),Health

cent) were wait-listed, 10 (28 percent) were not eligible for transplant for various reasons, 9 (26 percent) were too early in the course of their liver disease for a transplant, 3 (9 percent) were too sick for a transplant and four (11 percent) died during the evaluation process. The prolonged use of the drug lamivudine, which is used to treat both HIV and HBV, has led to lamivudine resistance in recent years and 67 percent of the referred patients had lamivudine-resistant HBV. Almost half of these patients were taking additional anti-HBV medications (tenofovir and/or adefovir) that are effective against lamivudine-resistant HBV. After the initial referral, 10 patients died of liver-related complications (the median follow-up was 7.5 months), the majority within three months of referral. A total of four patients ultimately underwent liver transplants and all of them survived and are without evidence of HBV recurrence.

"Our limited experience indicates patients with HIV-HBV coinfection can successfully undergo liver transplantation without progression of viral (HBV) disease, even in the setting of lamivudine resistance," the authors state. They suggest that the low rate of eligible candidates may be partially due to a lack of knowledge on the part of referring physicians about the indications and timing for liver transplants for HBV-HIV-infected patients. Patients taking tenofovir and/or adefovir were more likely to survive with or without a transplant, indicating that controlling HBV is an important factor in HIV-infected patients with liver disease. The authors conclude: "Ongoing close monitoring of HBV replication status in HBV-HIV coinfected patients will be essential in identifying the emergence of drug-resistant HBV and in making therapeutic decisions to minimize the risk of liver-related complications."

In an accompanying editorial in the same issue, Didier Samuel and Jean-Charles Duclos-Vallee of the Centre Hpatobillaire in Villejuif, France
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Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.
1-May-2006

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