HIV-positive patients have shorter survival periods while awaiting liver transplants

November 03, 2005

A new study on HIV-positive patients eligible for liver transplants found that their survival while waiting for a transplant is significantly shorter than patients who are HIV-negative. Other than infection, which caused many of the deaths, there appear to be no other factors that predict a poor outcome for these patients.

The results of this study appear in the November 2005 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

HIV-positive patients progress more rapidly to end-stage liver disease (ESLD), a condition requiring transplant, but post-transplant survival has improved in recent years, possibly because of advances in antiretroviral therapy. However, some patients do not survive long enough to undergo a transplant. Led by Margaret V. Ragni at the University of Pittsburgh School of Medicine, researchers studied whether poorer survival prior to transplant is related to the severity of either liver disease or HIV disease in these patients.

A total of 58 patients who were HIV-positive with ESLD were evaluated for transplant eligibility at the University of Pittsburgh Medical Center between 1997 and 2002. These patients were followed, along with 1,359 HIV-negative patients who were also evaluated for transplant. Of the 58 HIV-positive patients, 48 percent died before a transplant was performed, compared with 16 percent of the HIV-negative group. In addition, the survival period was much shorter in the HIV-positive group (880 versus 1,427 days), but the severity of their ESLD was no worse than the HIV-negative group. More than half of the deaths in the HIV-positive patients were due to infection.

The findings indicate that the development of ESLD in HIV-positive patients is associated with a high risk of early death. Speculating as to why this is the case, the authors state that "when ESLD develops in an HIV-positive individual, the already defective host defense against infection attributed to HIV may be further weakened by the immune defects associated with liver failure, resulting in a greater vulnerability of the HIV-positive candidate to infection or sepsis [an infection in the blood]." They further suggest that patients with HIV infection should be evaluated for transplant earlier in the course of their ESLD, as they appear to be at greater risk for infection, and that studies on whether prophylactic antibiotics may have a role in preventing this scenario may be warranted. They conclude: "Until then, it would seem prudent to monitor HIV-positive transplant candidates very closely for early signs of infection, inform them of the potential risk for infection, and urge them to seek medical attention at the earliest signs or symptoms of infection."

In the same issue, an accompanying editorial by Peter G. Stock, of the Department of Surgery at the University of California in San Francisco, CA notes that the study is the first documentation of a more rapid demise of HIV-patients awaiting transplant, adding that the importance of early transplant referral for these patients cannot be underestimated. The author suggests that transplant referral for HIV-positive patients may be delayed because HIV infection is still perceived by physicians as a barrier to undergoing a transplant, and these patients may therefore not be encouraged to meet the necessary transplant prerequisites in a timely manner, such as abstaining from alcohol and narcotics. In addition, the time it takes for the various specialists caring for HIV patients to coordinate a referral to a transplant center may be partially responsible for the delay. Also, by the time liver function in HIV infected patients deteriorates enough to warrant a transplant, they may no longer meet other criteria. The author notes that additional organs for these patients might be obtained via living donor grafts, which is not without risks to both donor and recipient, or the use of high infectious risk donors, excluding those who are HIV-positive. Although there is some concern about HIV transmission during a transplant procedure, the author states that the risk is actually much lower than the risk of transmission of Hepatitis C virus through a needle-stick. He concludes that "synchronized multi-special care along with early referral will help to minimize the number of deaths on the waiting lists and facilitate excellent outcomes following liver transplantation in this deserving group of recipients."
-end-
Article: "Pretransplant Survival Is Shorter in HIV-Positive Than HIV-Negative Subjects With End-Stage Liver Disease," Margaret V. Ragni, Bijan Eghtesad, Kimberly W. Schlesinger, Igor Dvorchik, John F. Fung, Liver Transplantation; November 2005 (DOI: 10.1002/lt.20534).

Editorial: "Rapid Deterioration of HIV Co-infected Patients Waiting for Liver Transplantation Is Not Predicted by MELD," Peter G. Stock, Liver Transplantation; November 2005 (DOI: 10.1002/lt.20539)

Wiley

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.