New hope in transplants for those living with HIV and hepatitis C
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Groundbreaking developments in HIV treatment are transitioning the disease into a chronic condition. Thankfully, patients can live long and full lives, but other challenges arise, particularly for those living with both HIV and the hepatitis C virus.
Roughly 2.3 million people in the world are living with both HIV and HCV and up to 15% have end-stage liver disease that will most likely require a liver transplant. We have made strides in organ transplants for patients with HIV since passage of the HOPE Act in 2013. Unfortunately, this has not applied to HIV/HCV co-infected individuals. But with the dawn of a new era that includes highly effective direct-acting antiviral (DAA) therapy, there is now hope for these patients.
Previous studies have shown worse liver transplant outcomes in patients with both HIV and HCV compared with patients with HIV or HCV alone. The reason for this is that we haven’t had an effective treatment for HCV – until now. With the advent of DAA therapy in 2013, the cure rate for HCV is between 95% and 100%.
In addition to being highly effective, the drugs are very tolerable, making them accessible to most patients. Because these new effective therapies have given so many hope for a bright future, our team at the University of Chicago Medicine wanted to know whether liver transplant outcomes for HIV/HCV co-infected patients have changed as well.
For our study — the results of which were presented at Digestive Disease Week 2021 — we looked at data from the Organ Procurement and Transplantation Network on 70,125 adult patients in the U.S. who underwent liver transplants between 2008 and 2019. There were 68 HIV/HCV co-infected patients in the pre-DAA era compared with 124 in the DAA era. We compared the outcomes of these liver transplant recipients with coinfection in the DAA era against recipients without coinfection, those with only HIV and those with only HCV in the DAA era. We also compared outcomes against recipients with coinfection in the pre-DAA era.
What we found was incredibly encouraging. Among coinfected liver transplant recipients in the DAA era, 1-year and 3-year cumulative graft survival rates (ie, transplant success rates) were 88.6% and 81.7%, compared with 76.3% and 58% in the pre-DAA era, respectively. There was no difference in patient survival outcomes in the HIV/HCV co-infected group compared with the uninfected group in the DAA era.
There are six centers in the U.S. that perform about 40% of the liver transplants for HIV/HCV co-infected patients. While these new data are promising for these patients, we are still facing an uphill battle to get transplant centers to adapt the practice of transplanting HIV/HCV co-infected patients. Currently, these patients make up fewer than 1% of liver transplants each year. This patient population is grossly underserved. With careful coordination between providers, including hepatologists, transplant surgeons, infectious disease physicians and pharmacists, patients with HIV/HCV co-infection can experience similar outcomes as patients with HIV only.
The results from our study should offer reassurance to transplant centers and encourage timely referral of HIV/HCV co-infected patients for consideration of liver transplantation. We need more transplant centers to take on the practice and get these patients the care they need and deserve.
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Wang J. Abstract 172. Presented at: Digestive Disease Week; May 21-23 (virtual meeting).
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