Virologic and Clinical Outcomes of Hepatitis B Virus Infection in HIV-HBV Coinfected Transplant Recipients.

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Am J Transplant. 2010 Mar 19. [Epub ahead of print]

Virologic and Clinical Outcomes of Hepatitis B Virus Infection in HIV-HBV

Coinfected Transplant Recipients.

Coffin CS, Stock PG, Dove LM, Berg CL, Nissen NN, Curry MP, Ragni M, Regenstein

FG, Sherman KE, Roland ME, Terrault NA.

Department of Medicine, University of California San Francisco, San Francisco,

CA.

Liver transplantation (LT) is the treatment of choice for end-stage liver

disease, but is controversial in patients with human immunodeficiency virus

(HIV) infection. Using a prospective cohort of HIV-hepatitis B virus (HBV)

coinfected patients transplanted between 2001-2007; outcomes including survival

and HBV clinical recurrence were determined. Twenty-two coinfected patients

underwent LT; 45% had detectable HBV DNA pre-LT and 72% were receiving anti-HBV

drugs with efficacy against lamivudine-resistant HBV. Post-LT, all patients

received hepatitis B immune globulin (HBIG) plus nucleos(t)ide analogues and

remained HBsAg negative without clinical evidence of HBV recurrence, with a

median follow-up 3.5 years. Low-level HBV viremia (median 108 IU/mL, range

9-789) was intermittently detected in 7/13 but not associated with HBsAg

detection or ALT elevation. Compared with 20 HBV monoinfected patients on

similar HBV prophylaxis and median follow-up of 4.0 years, patient and graft

survival were similar: 100% versus 85% in HBV mono- versus coinfected patients

(p = 0.08, log rank test). LT is effective for HIV-HBV coinfected patients with

complications of cirrhosis, including those who are HBV DNA positive at the time

of LT. Combination HBIG and antivirals is effective as prophylaxis with no

clinical evidence of HBV recurrence but low-level HBV DNA is detectable in

approximately 50% of recipients.

PMID: 20346065 [PubMed - as supplied by publisher]