Liver transplantation for patients coinfected with HIV and HBV results in good survival rates in the intermediate to long term, along with a low rate of postoperative complications. These results indicate that orthotopic liver transplantation (OLT) is a safe and viable option for patients with end-stage liver disease (ESLD) who are coinfected with HIV and HBV.
The median follow-up period for HIV recipients after OLT was 36 months, with an interquartile range from 12 to 39 months. Most patients maintained a stable CD4 T-cell count (over 200 copies/ul), had no detectable HBV DNA, and showed no detectable HIV RNA load during the follow-up period. The post-transplant survival rates at 1, 2, and 3 years were 85.7% for the HIV group, which remained consistent over the 3 years, compared to 82.2%, 81.2%, and 78.8% for the group without HIV.
“Our study found 85.7% survival of both patient and graft after a mean follow-up of 36 months (with a maximum follow-up of 43 months), demonstrating the applicability of liver transplantation in this subgroup of patients,” according to the investigators. “Compared with previous studies, the lower mortality rate in HIV/HBV coinfected patients is closely related to the development of efficient antiretroviral therapy, which has low drug resistance, high efficacy, and minimal interaction with commonly used immunosuppressive drugs.”
Main Takeaways
- Liver transplantation in patients coinfected with HIV and HBV shows promising outcomes, with good survival rates and low postoperative complications over an intermediate to long-term period.
- The study emphasizes the role of efficient antiretroviral therapy in managing HIV/HBV coinfected patients. Improved drug formulations that offer high efficacy with low resistance and minimal interaction with immunosuppressive drugs have contributed to the lower mortality rates observed in these patients compared to previous studies.
- Despite the positive outcomes, the study highlights significant limitations due to its retrospective design and regional focus.
The study was carried out on all patients coinfected with HIV and HBV who received OLT between April 1, 2019, and December 31, 2021. Outcomes were analyzed and compared with those of patients infected solely with HBV who also underwent OLT in the same timeframe. The assessment covered patient outcomes such as survival, viral load levels, CD4 T-cell counts, and postoperative complications.
The proportion of deaths due to infection was similar between the HIV and non-HIV groups (14.3% vs. 9.32%; P = .665). Following OLT there was not significant difference in the incidence of acute rejection, cytomegalovirus infection, bacteremia, pulmonary infection, acute kidney injury, the development of new tumors, and vascular and biliary complications.
“Notably, there was no significant difference in survival between HIV/HBV coinfected patients and HBV monoinfected patients after liver transplantation,” according to investigators. “5-year survival rate of HIV/HBV-coinfected patients was 80%, and none of the HIV/HBV-coinfected patients developed clinically relevant HBV-related end-stage liver disease after liver transplantation.”
The study's design and regional focus limit the wider applicability of its findings. The lack of standardization in post-transplant antiretroviral and immunosuppressive treatments suggests uncertainty in optimal patient care. It did not fully address long-term outcomes or examine how comorbidities and adherence to treatment affect survival and graft health.
The study supports the viability of liver transplantation for HIV/HBV coinfected patients facing severe liver disease, demonstrating that low CD4 T-cell counts are not an absolute barrier to transplantation. Positive patient outcomes, such as survival rates and effective viral management, affirm the feasibility of liver transplantation for this demographic in China. Limitations highlight the need for further research, ideally prospective, to establish comprehensive care guidelines for HIV/HBV coinfected individuals undergoing liver transplantation.
Reference
Tng, J., Weng, R., Fang, T. et.al. Clinical Outcomes of Liver Transplantation in Human Immunodeficiency Virus/Hepatitis B Virus Coinfected Patients in China. BMC Infect Dis. Published April 8, 2024. Accessed April 10, 2024. Doi: https://doi.org/10.1186/s12879-024-09284-2
