Liver transplant in people with HIV/HCV coinfection

When the liver can no longer adjust (or compensate) for damage, and liver function has become worse this is called hepatic decompensation (or decompensated cirrhosis).

Some DAAs can be used in people with decompensated liver disease. A liver specialist should oversee HCV treatment. Sometimes being cured improves liver function, but if it doesn’t a liver transplant might still be needed.

A transplant is a major operation, and success rates vary. Access is also complicated by a lack of donor organs.

ART now enables HIV positive people to have a liver transplant. Centres in the UK, Spain, France, Italy and the US have all reported successful transplants in HIV positive people. Some centres have reported survival rates that are similar to HIV negative people.

Medical management remains complex because of the risk of graft rejection. Using DAAs before and after transplant reduces the risk of HCV reinfection of the new liver.

Drug interactions between drugs used to suppress the immune system after the transplant and HIV/HCV protease inhibitors need to be carefully managed.

HCV progresses more quickly in people who are HIV positive, and survival after decompensation is shorter compared to people who are HIV negative.

This makes it important for people with coinfection to be referred to transplant services at an earlier stage of disease than people with HCV monoinfection.

Only a few transplant centres perform liver transplants in people with coinfection, and referral to one of these centres is essential.

When the liver can no longer adjust (or compensate) for damage, and liver function has become worse this is called hepatic decompensation (or decompensated cirrhosis).

In people with decompensated liver disease, HCV treatment can no longer be used and a liver transplant is needed.

A transplant is a major operation, and success rates vary. It is also complicated by a lack of donor organs.

For many years, transplant services actively avoided liver transplants in HIV positive people. HIV was an exclusion criteria for a liver transplant.

Effective HIV treatment changed this and centres in the UK, Spain, France, Italy and the US have reported successful transplants in HIV positive people. Some centres have reported similar survival rates as HIV negative people.

Medical management remains complex and success is largely related to the risk of HCV reinfection of the new liver. There is also the risk of graft rejection.

Drug interactions between drugs used to suppress the immune system after the transplant and HIV/HCV protease inhibitors need to be carefully managed and it can also be difficult to tolerate HIV and HCV treatment after the transplant.

New HCV drugs may be more effective, safe and tolerable both before and after a liver transplant, although information is so far very limited.

HCV progresses more quickly in people with HIV positive people, and survival after decompensation is shorter that HIV negative people.

This makes it important for people with coinfection to be referred for transplantation at an earlier stage of disease than people with HCV monoinfection.

Only a few transplant centres perform liver transplants in people with coinfection, and referral to one of these centres is essential.