Patients Coinfected with HIV and Hepatitis B Virus Can Undergo Liver Transplantation with Excellent Results

Prior studies have shown that cirrhosis and other liver complications tend to progress more rapidly and with greater severity in individuals coinfected with HIV and hepatitis B virus (HBV) compared to patients with hepatitis B alone.

Since the advent of effective antiretroviral therapy, organ transplantation is no longer considered contraindicated for HIV positive recipients, but extensive data are lacking regarding the outcome of liver transplantation in HIV-HBV coinfected patients, including survival rates, HBV reactivation, and mitochondrial toxicity -- a potential adverse effect of certain antiretroviral drugs -- in the new liver graft.

To learn more about these poorly understood outcomes, French researchers prospectively studied 13 HIV positive patients who underwent liver transplantation because of end-stage liver disease due to HBV, with or without coinfection with hepatitis C virus (HCV) or hepatitis delta virus (HDV).

Between November 2002 and June 2007, participants were prospectively followed for an average of 32 months. Results from the study, published in the June 1, 2009 issue of AIDS, are summarized below:

Results

All patients in the study were still alive at the end of the follow-up period.

All patients had normal liver function at the end of the study.

In all patients, HBV viral load was undetectable and no cccDNA was found in the liver graft.

HIV infection was well controlled and non-progressive with antiretroviral therapy.

No mitochondrial toxicity was noted in transplanted liver grafts.

Based on these findings, the study authors concluded, "HBV-HIV coinfected patients can successfully undergo liver transplantation with excellent results in terms of survival, control of HBV replication after transplantation, and mitochondrial toxicity."

HBV recurrence in the new liver can be prevented using a combination of hepatitis B immune globulin, hepatitis B vaccination, and antiviral drugs (which may be continued long-term). Therefore, transplant outcomes for HIV-HBV coinfected individuals are typically better than those for HIV-HCV coinfected patients, who face complications due to HCV recurrence in the new liver despite interferon-based therapy.

AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, France; Univ Paris-Sud, UMR-S 785, France; Inserm, U785, Villejuif, France; Inserm, U582, France; Université Pierre et Marie Curie-Paris 6, France; AP-HP Groupe hospitalier Pitié-Salpêtrière, Biochimie métabolique, Paris, France; AP-HP Hôpital Paul Brousse, Laboratoire de Virologie, France; AP-HP Hôpital Paul Brousse, Service des Maladies Infectieuses, France; AP-HP Hôpital Paul Brousse, Laboratoire d'Anatomopathologie, Villejuif, France; University of Bari, Department of Clinical Medicine, Immunology and Infectious Disease, Bari, Italy.

6/05/09

Reference
M Tateo, AM Roque-Afonso, TM Antonini, and others. Long-term follow-up of liver transplanted HIV/hepatitis B virus coinfected patients: perfect control of hepatitis B virus replication and absence of mitochondrial toxicity. AIDS 23(9): 1069-1076. June 1, 2009.