Infections and immunosuppression as specific problems in a HIV + patient transplanted for end-stage alcoholic cirrhosis

We report the case of a 54-year old man with decompensated alcoholic liver cirrhosis and HIV infection who underwent liver transplantation (LT). Due to relatively well preserved cellular immunity until 2003, no antiretroviral therapy (HAART) needed to be instituted. However, deterioration of his cli...

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Bibliographic Details
Published in:Acta chirurgica belgica 2007-03, Vol.107 (2), p.215-218
Main Authors: RICCIARDI, S, VAN WANZEELE, F, TROISI, R
Format: Article
Language:English
Subjects:
AIDS-Related Opportunistic Infections - complications
Antiretroviral Therapy, Highly Active
Biological and medical sciences
CD4 Lymphocyte Count
Drug Interactions
General aspects
Graft Rejection - prevention & control
HIV Infections - complications
HIV Infections - drug therapy
Human viral diseases
Humans
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - adverse effects
Infectious diseases
Liver Cirrhosis, Alcoholic - surgery
Liver Transplantation
Male
Medical sciences
Middle Aged
Tacrolimus - administration & dosage
Tacrolimus - adverse effects
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:We report the case of a 54-year old man with decompensated alcoholic liver cirrhosis and HIV infection who underwent liver transplantation (LT). Due to relatively well preserved cellular immunity until 2003, no antiretroviral therapy (HAART) needed to be instituted. However, deterioration of his clinical state indicated LT. At that time, the viral load was of 4.84 Log and the CD4 count was more than 250 cells/mm(3). The posttransplant course was complicated by several infection episodes and one episode of acute cellular rejection grade 2. HAART consisted of Lamivudine, Stavudine, Lopinavir and Ritonavir. One week after beginning of HAART, tacrolimus was discontinued during 18 days due Ritonavir interaction. CD3/CD4 T-helper lymphocyte count showed a significant decrease immediately after LT which rapidly recovered after initiation of HAART. The patient was discharged on the 8th postoperative week in good conditions. This report encourages the institution of HAART once the liver graft regains normal function. Drug interactions between Ritonavir and Tacrolimus should be anticipated. A study protocol to manage these patients within a multidisciplinary team including also specialists in infectious diseases and virologists is mandatory.
ISSN:0001-5458
DOI:10.1080/00015458.2007.11680044