Reuters Health Information (2006-05-11): Liver transplantation not necessarily contraindicated in patients with HBV and HIV
Liver transplantation not necessarily contraindicated in patients with HBV and HIV
Last Updated: 2006-05-11 12:29:22 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Selected patients with HIV and hepatitis B virus (HBV) coinfection can undergo successful liver transplantation, according to researchers at the University of California, San Francisco.
In the May issue of Liver Transplantation, Dr. Norah A. Terrault and colleagues note that the outcome of the procedure in such patients is unknown. In particular, they add, the role of lamivudine-resistant HBV in raising failure risks has not been ascertained.
To investigate, the researchers examined the outcome of 35 HIV-HBV coinfected patients referred for liver transplantation. The majority (67%) had lamivudine-resistant HBV. Almost half of this group were taking tenofovir and adefovir.
Twenty-six patients were excluded for a variety of reasons. Of these, nine were deemed as being too early for transplantation, three were too sick to be considered, four died during the evaluation process and ten had contraindications.
Nine patients were wait-listed for transplantation. Of this group, four went on to have liver transplantation. At a median of close to 3 years of follow-up, the transplanted patients, who are receiving anti-HBV prophylaxis with hepatitis B immune globulin plus lamivudine with or without tenofovir or adefovir, show no signs of HBV recurrence.
Dr. Didier Samuel at Centre Hepatobiliaire of INSERM in Villejuif, France, co-author of an accompanying editorial, told Reuters Health, "coinfected HIV/HBV and HIV/HCV patients have a more severe course of liver disease than monoinfected HBV or HCV patients and should be referred early to transplant centers."
These patients, he added, "should not be treated by HIV specialists alone, and should be treated by hepatologists and HIV specialists; a multidisciplinary approach is necessary."
Liver Transpl 2006;12:699-701,801-807.