What Is the Biopsychosocial Role of Human Immunodeficiency Virus Positivity in Patients With End-Stage Liver Disease Who Undergo Orthotopic Liver Transplantation?

• Published in: Transplantation proceedings 2008-07, Vol.40 (6), p.1910-1912
• Main Authors: Silva, V. Barbanti, Ferrara, M, Mazzi, F, Pingani, L, Cocchi, S, Romano, A, Masetti, M, Gerunda, G.E, Guaraldi, G, Rigatelli, M
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Depression - epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis C - complications; HIV Seropositivity - complications; HIV Seropositivity - physiopathology; HIV Seropositivity - psychology; Human viral diseases; Humans; Infectious diseases; Liver Failure - complications; Liver Failure - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Mental Disorders - epidemiology; Mood Disorders - epidemiology; Prospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.05.060

Abstract Introduction Since 2003 the National Research Program for Solid Organ Transplantation in patients with human immunodeficiency virus (HIV) is active at our liver transplantation center. Patients with HIV who enter this protocol are assessed by the Consultation Liaison Psychiatry Service. The aim of the present study was to evaluate their psychiatric comorbidity. Methods An observational prospective study was conducted comparing end-stage liver disease (ESLD) patients with and without HIV. After the assessment, the psychiatrist compiled the Transplant Evaluation Rating Scale (TERS) and the Montgomery Asberg Depression Rating Scale (MADRS). Baseline evaluation was made before inclusion on the OLT waiting list and the follow-up evaluation was made 12 months later. Results From January 2003 to December 2006 we assessed 553 patients: 39 (6%) with HIV and 361 (94%) without HIV. The 2 groups were homogeneous for gender (75% of male patients; P = not significant [NS]) but not for age (46 ± 5 vs 56 ± 9; P = NS). Psychiatric history was negative in 176 (49%) patients without HIV and in 6 (15%) patients with HIV ( P < .001). At baseline psychiatric comorbidity was present in 33 HIV patients (85%) and in 148 non-HIV patients (41%; P < .001). At follow-up MADRS highlighted an improvement in all of the items for HIV patients. In the non-HIV group, the variation was as follows: baseline, 7.10; follow-up, 8.15. In the HIV group, the variation was as follows: baseline, 10.20; follow-up, 4.09 ( P < .001). The average score at TERS was higher among patients with HIV (43 ± 9 vs 35 ± 9; P = NS). Conclusions At baseline HIV patients with ESLD showed a higher rate of psychopathology, but they improved at follow-up; the contrary happened in the non-HIV group.