Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus

Authors

  • Jean-Charles Duclos-Vallée,

    Corresponding author
    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
    • Institut National de la Santé et de la Recherche Médicale Unité 785, Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, 12-14 Avenue Paul Vaillant Couturier, 94804 Villejuif Cedex, France
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    • fax: (33) 1 45 59 38 57

  • Cyrille Féray,

    1. Institut des Maladies de l'Appareil Digestif, CHU Hôtel Dieu, Nantes, France
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  • Mylène Sebagh,

    1. Laboratoire d'Anatomopathologie, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Elina Teicher,

    1. Unité des Maladies Infectieuses, AP-HP Hôpital Paul Brousse, Villejuif, France
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  • Anne-Marie Roque-Afonso,

    1. Laboratoire de Virologie, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Bruno Roche,

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Daniel Azoulay,

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • René Adam,

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Henri Bismuth,

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
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  • Denis Castaing,

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Daniel Vittecoq,

    1. Unité des Maladies Infectieuses, AP-HP Hôpital Paul Brousse, Villejuif, France
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  • Didier Samuel

    1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
    2. UMR-S 785, Université Paris Sud, Villejuif, France
    3. Institut National de la Santé et de la Recherche Médicale Unité 785, Villejuif, France
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  • Potential conflict of interest: Dr. Didier is a consultant for Novartis and Astellas Pharma.

  • The members of the THEVIC study group are listed in the appendix.

Abstract

Liver transplantation in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a recent indication. In a single center, we have compared the survival and severity of recurrent HCV infection after liver transplantation in HIV-HCV–coinfected and HCV-monoinfected patients. Seventy-nine patients receiving a first liver graft for HCV-related liver disease between 1999 and 2005 were included. Among them, 35 had highly active antiretroviral therapy–controlled HIV infection. All patients were monitored for HCV viral load and liver histology during the posttransplantation course. Coinfected patients were younger (43 ± 6 versus 55 ± 8 years, P < 0.0001) and had a higher Model for End-Stage Liver Disease (MELD) score (18.8 ± 7.4 versus 14.8 ± 4.7; P = 0.008). The 2-year and 5-year survival rates were 73% and 51% and 91% and 81% in coinfected patients and monoinfected patients, respectively (log-rank P = 0.004). Under multivariate Cox analysis, survival was related only to the MELD score (P = 0.03; risk ratio, 1.08; 95% confidence interval, 1.01, 1.15). Using the Kaplan-Meier method, the progression to fibrosis ≥ F2 was significantly higher in the coinfected group (P < 0.0001). Conclusion: The results of liver transplantation in HIV-HCV–coinfected patients were satisfactory in terms of survival benefit. Earlier referral of these patients to a liver transplant unit, the use of new drugs effective against HCV, and an avoidance of drug toxicity are mandatory if we are to improve the results of this challenging indication for liver transplantation. (HEPATOLOGY 2007.)

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