HCV Recurrence in HIV-Infected Patients After Liver Transplant

• Published in: Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002) Ill. : 2002), 2010-03, Vol.9 (2), p.87-93
• Main Authors: Hughes, Christopher B., Dickson, Rolland C., Krishna, Murli, Willingham, Darrin L., Satyanarayana, Raj, Harnois, Denise M., Keaveny, Andrew P., Rosser, Barry, Aranda-Michel, Jaime, Kramer, David J., Hellinger, Walter, Mendez, Julio
• Format: Article
• Language: English
• Subjects: Adult; Aggressiveness; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - virology; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biopsy; Blood diseases; Hepacivirus - drug effects; Hepatitis; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C - virology; Hepatitis C virus; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; Human immunodeficiency virus; Humans; Liver; Liver - pathology; Liver - virology; Liver Failure - drug therapy; Liver Failure - mortality; Liver Failure - pathology; Liver Failure - virology; Liver Transplantation - adverse effects; Liver transplants; Middle Aged; Patients; Recurrence; Risk Factors; Survival Analysis; Transplants & implants
• ISSN: 1545-1097; 2325-9574; 1557-0886; 2325-9582
• DOI: 10.1177/1545109710362592

Patients coinfected with hepatitis C virus (HCV) and HIV undergoing liver transplantation (LT) are at risk of early, aggressive HCV recurrence. This study investigates the use of frequent protocol-driven biopsies to identify HCV recurrence post LT in coinfected patients. Five consecutive HIV/HCV-coinfected patients underwent LT. Liver biopsies were obtained post LT at 1 hour; days 7, 120, and 365; then annually; and as clinically indicated. Stage 2 (Ishak) or higher fibrosis occurred in 4 of the 5 patients by 60, 120, 270, and 365 days. Two patients died of HCV recurrence and liver failure at 6 and 35 months post LT. Three patients survived more than 4 years after LT, 2 having sustained virologic responses to anti-HCV treatment. Another has histologic recurrence not responding to treatment. Hepatitis C virus recurrence can be rapid and aggressive after LT in HIV-coinfected patients. Serial biopsies identify recurrence early, allowing for prompt initiation of treatment.