Liver Transplantation for HIV/HCV Coinfection

Where Is the Controversy?

Emily Dannhorn; James P O'Beirne


Future Virology. 2013;8(7):639-648. 

In This Article

The Burden of Liver Disease in HIV Infection

Once regarded as a terminal disease, with the development of highly effective cART, HIV is now considered a chronic illness. Since its introduction in the 1990s, cART has significantly decreased rates of AIDS and AIDS-related deaths.[7] Half of the deaths occurring within patients established on cART regimens are not AIDS related. Liver disease is now the main non-AIDS cause of death in HIV-positive patients, having recently overtaken deaths due to cardiovascular disease. The vast majority of these deaths (over 90%) are associated with coinfection with chronic HCV and/or HBV.[8]

HIV is often associated with HCV and HBV coinfection due to comparable modes of transmission. Prevalence of coinfection with hepatitis C and HIV varies, but it is estimated that in the USA and Europe, up to a third of HIV-positive patients are coinfected (an estimated 300,000 individuals in the USA).[9] Rates of coinfection reaching up to 70% have been documented in eastern Europe, where the most common route of transmission is intravenous drug use.[10] Multiple infections (HIV, HBV and HCV) are most prevalent within intravenous drug users.

Due to the now near-normal life expectancy of individuals with HIV, other types of liver disease are also becoming important causes of morbidity and mortality, including drug-induced liver injury and nonalcoholic fatty liver disease.[3] These conditions also impact upon the numbers of coinfected patients developing end-stage liver disease. The number of patients with HIV and end-stage liver disease is increasing, and it is therefore clear that LT in HIV-infected patients is a partially unmet need, especially in coinfected patients, which urgently requires addressing.