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HCV/HIV coinfection contributes to mortality of patients awaiting LT

Research published in Liver Transplantation suggests coinfection with hepatitis C and HIV plays a role in death before liver transplantation, resulting in higher death rates on the waiting list.

“Our study indicates that, in addition to being a risk factor after transplantation, HCV/HIV coinfection is also a factor for mortality prior to transplantation and associated with higher mortality on the waiting list,” Juan J. Araiz, MD, professor of transplant procurement management at the Universidad Zaragoza in Spain, and researchers wrote.

Araiz and colleagues retrospectively studied 199 patients —17 with both HCV and HIV. When compared with all patients with HCV monoinfection, those with coinfection were more likely to succumb (35.3% vs. 4.5%; P < .001). This led to fewer coinfected transplant recipients (52.9% vs. 83.5%; P < .01). The intention-to-treat (ITT) analysis of survival rates of patients with only HCV was 75% at 1 year, 64% at 3 years and 57% at 4 years. For coinfected patients, survival rate was 52% at 1 year, 47% at 3 years and 39% at 4 years. 

Using a Wilcoxon test, researchers showed a significant difference in death rate among patients with both infections vs. those with monoinfection (P < .005). When broken into two groups, short-term of less than 1 year and long-term survival,  the short-term survival time frame included higher mortality in the coinfection group (P < .01). These rates were more noticeable in the first few months and held steady after the third month, according to researchers.

A Cox regressional analysis revealed HIV coinfection (HR = 2.65; P < .05), MELD score (HR = 1.13; P < .001), United Network for Organ Sharing status 1 (HR = 10.1; P < .01) and donor age (>70; HR = 3.12; P < .05) adversely affected a patient’s chance for survival.

“LT is a possible treatment for patients with HCV/HIV coinfection and end-stage liver disease, but these patients have lower short-term survival … mainly related to higher mortality on the waiting list,” Araiz and researchers wrote.  

Araiz and colleagues conducted their analysis before new direct-acting antiviral agents were shown to be reliable in curing HCV, Garrett R. Roll, MD, and Peter G. Stock, MD, PhD, of the department of surgery at the University of California San Francisco, wrote in a related editorial.

“Treatment with these newer agents will undoubtedly improve survival in the HCV/HIV-coinfected patients on the waiting list and following transplantation,” they wrote. – by Janel Miller