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Lynch EN, Russo FP. Liver Transplantation in People Living with HIV: Still an Experimental Procedure or Standard of Care? Life (Basel) 2023; 13:1975. [PMID: 37895356 PMCID: PMC10608432 DOI: 10.3390/life13101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Liver transplantation (LT) is the only curative treatment for various liver diseases, including acute liver failure, end-stage liver disease, and selected unresectable liver malignancies. Combination antiretroviral therapy has improved outcomes for people living with HIV (PLWH), transforming the status of acquired immune deficiency syndrome from a fatal disease to a chronic and manageable condition. These powerful antiviral therapies have not only increased the number of HIV+ enlisted patients by improving their survival but also made the use of HIV+ organs a viable option. In this review, we summarise current knowledge on the peculiarities of liver transplantation in PLWH. In particular, we focus on the indications, contraindications, specific considerations for treatment, and outcomes of LT in PLWH. Finally, we present available preliminary data on the use of HIV+ liver allografts.
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Affiliation(s)
- Erica Nicola Lynch
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Section, Padua University Hospital, 35128 Padua, Italy;
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Section, Padua University Hospital, 35128 Padua, Italy;
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Rossotti R, Merli M, Mazzarelli C, De Carlis RM, Travi G, Vecchi M, Viganò R, Lauterio A, Raimondi A, Belli LS, De Carlis LG, Puoti M. Similar survival but higher and delayed hepatocellular carcinoma recurrence in HIV-positive compared to negative cirrhotics undergoing liver transplantation. Dig Liver Dis 2023; 55:268-275. [PMID: 35644890 DOI: 10.1016/j.dld.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Liver transplantation (LT) represents the best therapeutic option for hepatocellular carcinoma (HCC) and end-stage liver disease (ESLD). Although HIV infection does not seem to lower survival rates, HCV and HCC recurrence appear more harmful. AIMS To compare the overall survival after LT; evaluate the impact of anti-HCV direct-acting agents (DAA); assess the rate of HCC recurrence in HIV-positive and negative patients. METHODS Subjects with HCV/HBV infection who underwent LT for HCC or ESLD from 2012 to 2019 were retrospectively evaluated. RESULTS Study population included 299 individuals, 31 (10.4%) were HIV-positive. Overall mortality was similar (16.1% versus 19.0%, p = 0.695). HCC recurrence was observed in 6 HIV-positive (19.4%) and in 17 negative subjects (6.3%, p = 0.022). Time to relapse was 831 days in HIV-positive and 315 days in negative patients (p = 0.046). Cox model found a significant role for HIV in univariate analysis but, after adjusting for variables, extra-hepatic tumor was the only factor associated to recurrence (aHR 56.379, p < 0.001). CONCLUSIONS Post-LT survival improved after DAA availability and HIV has no impact on mortality. A higher and delayed rate of HCC recurrence was observed in co-infected individuals: surveillance protocols should be strengthened along time in this population.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marco Merli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Maria De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Travi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Vecchi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaella Viganò
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Saverio Belli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano Gregorio De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine, University of Milan-Bicocca, Milan, Italy
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Cammarata F, Benuzzi L, Crespi M, Troci A, Pennacchi L, Schiavini M, Foschi D. Liver resection of hepatocellular carcinoma in HIV-HCV co-infected patients: a retrospective case series. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Despite the effectiveness of new therapies and awareness campaigns, the number of seropositive patients is increasing every year. Recently, other causes of death, not directly related to HIV, have emerged, such as chronic liver disease. The risk of hepatocellular carcinoma (HCC) is seven times greater in HIV patients than in noninfected patients, and it is especially attributable to HCV infection. The aim of our study was to evaluate clinical outcomes of HCC in HIV-HCV co-infected patients after liver resection (LR).
Materials and methods
The current study was conducted on a prospective database and reviewed retrospectively. All consecutive patients with HCC treated by LR from January 2013 to March 2019 at the Luigi Sacco University Hospital in Milan were enrolled. We included patients older than 18 years of age with HCV-related HCC, and in this set of patients, we identified two groups based on the presence of HIV infection.
Results
We identified 16 patients with HCV infection and precisely five with HIV-HCV co-infection and eleven with HCV infection alone. All HIV patients were male against 72.7% in the non-HIV group (p = 0.509). All patients had optimal HIV virologic control and a normal CD4 T-cell count. The mean diagnosis-to-treatment interval was statistically different between the two groups (HIV versus non-HIV: 1.2 ± 0.55 months versus 2.39 ± 1.09 months, p = 0.039).
No other significant differences were found between HIV-HCV co-infected patients and HCV-infected patients. Long-term outcomes in terms of OS and RFS were similar between the two groups.
Conclusions
With a multidisciplinary approach and intensive support, LR can be a safe and efficacious procedure in HIV-HCV patients. For these reasons, we should not exclude potential patients merely on the basis of their HIV seropositivity.
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Zhong H, Liu CY, Dai YQ, Zhu C, Le KJ, Pang XY, Li YJ, Gu ZC, Yu YT. A bibliometric analysis of infectious diseases in patients with liver transplantation in the last decade. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1646. [PMID: 34988155 PMCID: PMC8667120 DOI: 10.21037/atm-21-2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND A bibliometric analysis was performed to reveal the current status of investigations in infectious diseases in patients with liver transplantation (LT) and to prioritize future research needs. METHODS The present study comprehensively retrieved publications relevant to infectious diseases in LT recipients published between 2010 and 2020. The search was conducted on the Web of Science (WoS) database. A bibliometric analysis was conducted through machine learning and visualization tools, including VOSviewer, Bibliographic Item Co-Occurrence Matrix Builder, and Graphical Clustering Toolkit. Research hotspots and trends in the field were assessed, while the contributions and collaborations of countries, institutions, and authors were documented. RESULTS A total of 691 publications were analyzed. Research output sharply increased in 2015, with a fast drop afterward. "Liver transplantation" was the most frequent keyword, with strong links to "hepatitis C virus" and "infection". Study areas included risk factors of infectious diseases in LT recipients, pathogens causing post-transplantation infections, antibacterial therapy and prophylaxis for peritransplant infection complications, living donor LT, and pediatric LT. The efficacy and safety of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection among liver transplant recipients has attracted recent research interest. Didier Samuel was the most productive author, while Xavier Forns was the top-cited author. Shanghai Jiao Tong University was the most productive contributor, and Gilead Sciences was the most cited organization. Moreover, the USA was the greatest contributor. Gastroenterology was the most cited journal, while Liver Transplantation was the most prolific journal. CONCLUSIONS This bibliometric analysis will better understand the research status of infectious complications in LT recipients and forecast future research trends. Priority should be given to identifying risk factors for peritransplantation infections and effective treatments against infectious complications in the coming years.
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Affiliation(s)
- Han Zhong
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Pharmacy, Ningbo Hangzhou Bay Hospital, Ningbo, China
| | - Chun-Yan Liu
- Department of Emergency, Minhang District Central Hospital, Shanghai, China
| | - You-Qin Dai
- Department of Pharmacy, Ningbo Hangzhou Bay Hospital, Ningbo, China
| | - Cheng Zhu
- Department of Disease Prevention and Control, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ke-Jia Le
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Yun Pang
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Jie Li
- Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue-Tian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Guerrini GP, Berretta M, Guaraldi G, Magistri P, Esposito G, Ballarin R, Serra V, Di Sandro S, Di Benedetto F. Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience. Cancers (Basel) 2021; 13:cancers13184727. [PMID: 34572954 PMCID: PMC8471924 DOI: 10.3390/cancers13184727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. AIM To address the results of liver transplantation (LT) for HCC in HIV-infected patients. METHODS All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. RESULTS Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (p = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83, p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18, p< 0.001), HCC diameter (HR 1.16, p = 0.028), and number of HCC nodules (HR 1.26, p = 0.003) were predictors of recurrence post-LT. CONCLUSION Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.
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Affiliation(s)
- Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Massimiliano Berretta
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Giovanni Guaraldi
- Infectious Diseases Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy;
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Giuseppe Esposito
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Valentina Serra
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy; (G.P.G.); (P.M.); (G.E.); (R.B.); (V.S.); (S.D.S.)
- Correspondence:
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"Raising HOPE": Improved Outcomes for HIV/HCV-coinfected Liver Transplant Recipients in the Direct-acting Antiviral Era. Transplant Direct 2021; 7:e707. [PMID: 34124343 PMCID: PMC8191686 DOI: 10.1097/txd.0000000000001154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
The 2013 HIV Organ Policy Equity Act has increased liver transplantation (LT) in HIV+ patients; however, transplant centers may remain reluctant to perform LT in HIV/hepatitis C virus (HCV)-coinfected patients due to inferior outcomes. We aimed to assess how direct-acting antivirals (DAAs) have impacted HIV+/HCV+-coinfected LT recipient outcomes.
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7
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Comparative analysis of outcomes after liver resection and liver transplantation for early stages hepatocellular carcinoma in HIV-infected patients. An intention-to-treat analysis. HPB (Oxford) 2020; 22:900-910. [PMID: 31734238 DOI: 10.1016/j.hpb.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/15/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND To address the results of resection for hepatocellular carcinoma (HCC) in human immunodeficiency virus (HIV)-carriers, and to compare them against survival after liver transplantation (LT). METHODS All patients with HIV and HCC listed for LT (candidates = LTc+) or resection (LR+) between 2000 and 2017 in our centre were analysed and compared for overall survival (OS) and disease-free survival (DFS). RESULTS The LTc + group (n = 43) presented with higher MELD scores and more advanced portal hypertension and HCC stages than LR + group (n = 15). One-, 3- and 5-year intention-to-treat survival rates were: 81%, 60% and 44%, versus 86%, 58% and 58% in the LTc+ and LR + groups, respectively (p = 0.746). Eleven LTc + patients dropped out. After LT, OS was 81%, 68% and 59% (no difference with LR + group; p = 0.844). There tended to be better DFS after LT, reaching 78%, 68% and 56% versus 53%, 33% and 33% in the LR + group (p = 0.062). CONCLUSION This was the largest series of resections for HCC in HIV + patients and the first intention-to-treat analysis. Although LT and resection do not always concern the same population, they enable equivalent survival. At the price of higher recurrence rate, resection could be integrated in the global armoury of liver surgeons.
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Eman P, Chacon E, Gupta M, Berger JC, Shah MB, El Haddad HE, El-Husseini A, Dela Cruz AC, Grigorian A, Mei X, Gedaly R. Long term outcomes of patients transplanted for hepatocellular carcinoma with human immunodeficiency virus infection. HPB (Oxford) 2019; 21:1009-1016. [PMID: 30765199 DOI: 10.1016/j.hpb.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to study outcomes in HIV + patients with HCC in the US following Liver Transplantation (LT) using the UNOS dataset. METHODS The database was queried from 2003 to 2016 for patients undergoing LT with HCC, HIV+, and HCC/HIV+. RESULTS Out of 17,397 LT performed for HCC during the study period, 113 were transplanted for HCC with HIV infection (91 isolated livers). Patients transplanted for HCC/HIV+ were younger (55.54 ± 5.89 vs 58.80 ± 7.37, p < 0.001), had lower total bilirubin (1.20 vs 1.60, p = 0.042) significantly lower BMI (25.35 ± 4.43 vs 28.39 ± 5.17, p < 0.001) and were more likely to be co-infected with HBV (25.3% vs 8.2% p < 0.001) than those transplanted for HCC alone. HCC/HIV + patients were found to have a 3.8 fold increased risk of peri-operative mortality at 90 days after matching. HCC/HIV + recipients had 54% decreased long-term survival within the HCC cohort. Our initial analysis of overall graft and patient survival found significant differences between HCC/HIV and HCC/HIV + recipients. However, these variances were lost after case-matching. Recurrence and disease free survival were similar in HCC alone vs HCC/HIV + recipients. CONCLUSIONS Our analysis suggests that excellent outcomes can be achieved in selected patients with HCC/HIV+.
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Affiliation(s)
- Pedro Eman
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Eduardo Chacon
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Meera Gupta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Jonathan C Berger
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Malay B Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Hanine E El Haddad
- Department of Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Amr El-Husseini
- Department of Medicine, Division of Nephrology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anna C Dela Cruz
- Department of Medicine, Division of Gastroenterology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Alla Grigorian
- Department of Medicine, Division of Gastroenterology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Xiaonan Mei
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA.
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Blumberg EA, Rogers CC. Solid organ transplantation in the HIV-infected patient: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13499. [PMID: 30773688 DOI: 10.1111/ctr.13499] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the management of transplantation in HIV-infected individuals. Transplantation has become the standard of care for patients with HIV and end-stage kidney or liver disease. Although less data exist for thoracic organ and pancreas transplantation, it is likely that transplantation is also safe and effective for these recipients as well. Despite what is typically a transient decline in CD4+ T lymphocytes, HIV remains well controlled and infection risks are similar to those of HIV-uninfected transplant recipients. The availability of effective directly active antivirals for the treatment of Hepatitis C is likely to improve outcomes in HIV and HCV co-infected individuals, a population previously noted to have decreased survival. Drug interactions remain an important consideration, and integrase inhibitor-based regimens are preferred due to the absence of interactions with calcineurin and mTOR inhibitors. Additionally, despite the use of more potent immunosuppression, rejection rates exceed those found in HIV-uninfected recipients. Ongoing research evaluating HIV-positive organ donors may provide support for utilizing these donors for HIV-positive patients in need of transplantation.
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Affiliation(s)
- Emily A Blumberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Pierrotti LC, Litvinov N, Costa SF, Azevedo LSFD, Strabelli TMV, Campos SV, Odongo FCA, Reusing-Junior JO, Song ATW, Lopes MIBF, Batista MV, Lopes MH, Maluf NZ, Caiaffa-Filho HH, de Oliveira MS, Sousa Marques HHD, Abdala E. A Brazilian university hospital position regarding transplantation criteria for HIV-positive patients according to the current literature. Clinics (Sao Paulo) 2019; 74:e941. [PMID: 30942282 PMCID: PMC6432843 DOI: 10.6061/clinics/2019/e941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection.Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.
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Affiliation(s)
- Lígia Camera Pierrotti
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Nadia Litvinov
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Figueiredo Costa
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Sérgio Fonseca de Azevedo
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tânia Mara Varejão Strabelli
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Transplante Cardiaco, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Vidal Campos
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Pneumologia, Grupo de Transplante Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fatuma Catherine Atieno Odongo
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jose Otto Reusing-Junior
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alice Tung Wan Song
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Max Igor Banks Ferreira Lopes
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marjorie Vieira Batista
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marta Heloisa Lopes
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Natalya Zaidan Maluf
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Imunologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hélio Helh Caiaffa-Filho
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maura Salarolli de Oliveira
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Heloisa Helena de Sousa Marques
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edson Abdala
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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11
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Zhang ZH, Li LX, Li P, Lv SC, Pan B, He Q. Sirolimus in Liver Transplant Recipients with Hepatocellular Carcinoma: An Updated Meta-Analysis. J INVEST SURG 2018; 32:632-641. [PMID: 29557691 DOI: 10.1080/08941939.2018.1447053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Previous studies have indicated that sirolimus (SRL) may be effective for HCC patients undergoing liver transplantation (LT). However, the following results are still contradictory and do not have a clear conclusion. Therefore, we conducted an updated meta-analysis by retrieving published data in EMBASE, PubMed, and the Cochrane Library up to October 2017. Both efficiency and safety of SRL were analyzed using pooled odds ratio (ORs) with 95% confidence interval (CIs). A total of 11 studies involving 7,695 HCC patients were included. Compared with control group, SRL prolonged 1-year (OR = 2.44; CI = 1.66-3.59), 3 year (OR = 1.67; CI = 1.08-2.58) and 5-year (OR = 1.68; CI = 1.21-2.33) overall survival, as well as 1-year (OR = 2.13; CI = 1.19-3.81) disease-free survival. Pooled results found that SRL-treated patients had lower recurrence (OR = 0.60; CI = 0.37-0.98), lower recurrence-related mortality (OR = 0.58; CI = 0.42-0.81) and lower overall mortality (OR = 0.62; CI = 0.44-0.89). Moreover, fewer SRL-treated patients suffered from portal vein thrombosis (OR = 0.29; CI, 0.09-0.91) and diabetes (OR = 0.23; CI = 0.12-0.47), while SRL-treated patients were more vulnerable to acne compared with the control group (OR = 4.44; CI = 1.56-12.60). No significant differences in other adverse effects were found between two groups. Taken together, SRL-based immunosuppression is safe and effective in improving survival, as well as reducing recurrence and mortality for HCC patients following LT.
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Affiliation(s)
- Zhi-Hua Zhang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
| | - Li Xin Li
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
| | - Ping Li
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
| | - Shao-Cheng Lv
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
| | - Bing Pan
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
| | - Qiang He
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University , Beijing , China
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12
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Abstract
Liver-related morbidity and mortality is expanding in people living with HIV. Hepatocellular carcinoma (HCC), the third most lethal malignancy on a global scale, is a dominant complication of chronic liver disease and cirrhosis in patients with coexisting hepatitis. HIV infection further complicates the clinical heterogeneity of HCC, posing concurrent challenges stemming from the underlying immunological status of the patients and the ongoing need for combined antiretroviral therapy. In this article, we review the multiple clinical implications that characterize the multidisciplinary management of HCC in the context of HIV infection.
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13
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Araiz JJ, Serrano MT, García-Gil FA, Lacruz EM, Lorente S, Sánchez JI, Suarez MA. Intention-to-treat survival analysis of hepatitis C virus/human immunodeficiency virus coinfected liver transplant: Is it the waiting list? Liver Transpl 2016; 22:1186-96. [PMID: 27114030 DOI: 10.1002/lt.24474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 04/08/2016] [Indexed: 01/13/2023]
Abstract
In human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the accelerated severity of liver disease, associated comorbidities, and mortality on the waiting list could change the possibility and results of liver transplantation (LT). Intention-to-treat survival analysis (ITTA) can accurately estimate the applicability and efficacy of LT. The primary objective of this study was to compare the survival of patients with HCV with and without HIV infection. We analyzed a cohort of 199 patients with HCV infection enrolled for LT between 1998 and 2015; 17 were also infected with HIV. The patients with HCV/HIV coinfection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%; P < 0.001). ITTA at 1, 3, and 4 years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV coinfection, respectively (Wilcoxon test P < 0.05). The ITTA at 1, 3, 6, and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV coinfection, respectively (log-rank P < 0.05; Wilcoxon test P < 0.01). A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age > 70 years (hazard ratio [HR] = 3.12; P < 0.05), United Network for Organ Sharing status 1 (HR = 10.1; P < 0.01), Model for End-Stage Liver Disease (HR = 1.13; P < 0.001), and HIV coinfection (HR = 2.65; P < 0.05) had independent negative predictive value for survival. In conclusion, our study indicates that HIV coinfection is a factor in mortality prior to transplantation and associated with higher mortality on the waiting list. Liver Transplantation 22 1186-1196 2016 AASLD.
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Affiliation(s)
- Juan J Araiz
- Transplant Procurement Management, University Hospital Lozano Blesa, Zaragoza, Spain.,Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain
| | - M Trinidad Serrano
- Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain.,Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Francisco A García-Gil
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Hepatic Surgery Unit, Department of Surgery, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Surgery, University of Zaragoza, Zaragoza, Spain
| | - Elena M Lacruz
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Sara Lorente
- Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - José I Sánchez
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Miguel A Suarez
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain
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14
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Liver transplantation for hepatitis C virus in the era of direct-acting antiviral agents. Curr Opin HIV AIDS 2016; 10:361-8. [PMID: 26185921 DOI: 10.1097/coh.0000000000000186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Liver transplantation is widely used to treat HIV patients with an end-stage liver disease, mainly decompensated cirrhosis and hepatocellular carcinoma. The results are good especially in non-hepatitis C virus (HCV)-coinfected patients. In HIV-HCV-coinfected patients, 5-year post-liver transplantation survival is around 50-55%, negatively impacted by HCV recurrence. The results of PEG-IFN/RBV are poor in terms of efficacy and safety. In patients with genotype 1 infection, triple therapy (boceprevir or telaprevir) has increased sustained virological response (SVR) rate, but drug-drug interactions (DDIs) with immunosuppressive agents and high rates of adverse events lead to forsake these combinations. Herein, we provide new data and practical management regarding HIV-HCV liver transplantation patients using new direct-acting antiviral agents (DAA). RECENT FINDINGS The second-generation DAA have good safety profile. In patients who are candidates for liver transplantation or are already recipients, the optimal therapeutic option is to combine the new DAA. Efficacy results have dramatically improved with greater than 90% of SVR rate in many studies enrolling HCV-monoinfected liver transplant recipients. Some concerns persist in terms of DDI. SUMMARY Even sparse, data regarding efficacy and safety of these regimens in HCV-HIV-coinfected liver transplantation will radically change the prognosis of this peculiar population.
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15
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Gu XQ, Zheng WP, Teng DH, Sun JS, Zheng H. Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients. World J Gastroenterol 2016; 22:2749-2759. [PMID: 26973413 PMCID: PMC4777997 DOI: 10.3748/wjg.v22.i9.2749] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/13/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., “non-oncological factors”), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival.
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16
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Agüero F, Forner A, Manzardo C, Valdivieso A, Blanes M, Barcena R, Rafecas A, Castells L, Abradelo M, Torre-Cisneros J, Gonzalez-Dieguez L, Salcedo M, Serrano T, Jimenez-Perez M, Herrero JI, Gastaca M, Aguilera V, Fabregat J, Del Campo S, Bilbao I, Romero CJ, Moreno A, Rimola A, Miro JM. Human immunodeficiency virus infection does not worsen prognosis of liver transplantation for hepatocellular carcinoma. Hepatology 2016; 63:488-98. [PMID: 26516761 DOI: 10.1002/hep.28321] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/21/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED The impact of human immunodeficiency virus (HIV) infection on patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) is uncertain. This study aimed to assess the outcome of a prospective Spanish nationwide cohort of HIV-infected patients undergoing LT for HCC (2002-2014). These patients were matched (age, gender, year of LT, center, and hepatitis C virus (HCV) or hepatitis B virus infection) with non-HIV-infected controls (1:3 ratio). Patients with incidental HCC were excluded. Seventy-four HIV-infected patients and 222 non-HIV-infected patients were included. All patients had cirrhosis, mostly due to HCV infection (92%). HIV-infected patients were younger (47 versus 51 years) and had undetectable HCV RNA at LT (19% versus 9%) more frequently than non-HIV-infected patients. No significant differences were detected between HIV-infected and non-HIV-infected recipients in the radiological characteristics of HCC at enlisting or in the histopathological findings for HCC in the explanted liver. Survival at 1, 3, and 5 years for HIV-infected versus non-HIV-infected patients was 88% versus 90%, 78% versus 78%, and 67% versus 73% (P = 0.779), respectively. HCV infection (hazard ratio = 7.90, 95% confidence interval 1.07-56.82) and maximum nodule diameter >3 cm in the explanted liver (hazard ratio = 1.72, 95% confidence interval 1.02-2.89) were independently associated with mortality in the whole series. HCC recurred in 12 HIV-infected patients (16%) and 32 non-HIV-infected patients (14%), with a probability of 4% versus 5% at 1 year, 18% versus 12% at 3 years, and 20% versus 19% at 5 years (P = 0.904). Microscopic vascular invasion (hazard ratio = 3.40, 95% confidence interval 1.34-8.64) was the only factor independently associated with HCC recurrence. CONCLUSIONS HIV infection had no impact on recurrence of HCC or survival after LT. Our results support the indication of LT in HIV-infected patients with HCC.
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Affiliation(s)
- Fernando Agüero
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic- IDIBAPS, Barcelona, Spain.,CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas), Madrid, Spain
| | | | - Andres Valdivieso
- Hospital Universitario Cruces, Bilbao, Spain.,University of Basque Country, Bilbao, Spain
| | - Marino Blanes
- Hospital Universitario y Politécnic La Fe, Valencia, Spain
| | | | - Antoni Rafecas
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Lluis Castells
- CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas), Madrid, Spain.,Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Manuel Abradelo
- Servicio de Cirugía, Hospital Doce de Octubre, Madrid, Spain
| | | | - Luisa Gonzalez-Dieguez
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Magdalena Salcedo
- Department of Liver Transplantation, Hospital General Gregorio Marañón, Madrid, Spain
| | - Trinidad Serrano
- Liver Unit, University Hospital Lozano Blesa Zaragoza, IIS Aragon, Spain
| | - Miguel Jimenez-Perez
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Jose Ignacio Herrero
- CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas), Madrid, Spain.,Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mikel Gastaca
- Hospital Universitario Cruces, Bilbao, Spain.,University of Basque Country, Bilbao, Spain
| | - Victoria Aguilera
- CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas), Madrid, Spain.,Hospital Universitario y Politécnic La Fe, Valencia, Spain
| | - Juan Fabregat
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | - Asuncion Moreno
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Rimola
- CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas), Madrid, Spain.,Liver Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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17
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Spano JP, Poizot-Martin I, Costagliola D, Boué F, Rosmorduc O, Lavolé A, Choquet S, Heudel PE, Leblond V, Gabarre J, Valantin MA, Solas C, Guihot A, Carcelain G, Autran B, Katlama C, Quéro L. Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group. Ann Oncol 2015; 27:397-408. [PMID: 26681686 DOI: 10.1093/annonc/mdv606] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023] Open
Abstract
Malignancies represent a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The introduction of combined antiretroviral therapy has modified the spectrum of malignancies in HIV infection with a decreased incidence of acquired immunodeficiency syndrome (AIDS) malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma due to partial immune recovery and an increase in non-AIDS-defining malignancies due to prolonged survival. Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to optimally manage both diseases and drug interactions between anticancer and anti-HIV drugs. The French CANCERVIH group presents here a review and an experience of managing non-AIDS malignancies in HIV-infected individuals.
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Affiliation(s)
- J-P Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, AP-HP, Paris INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - I Poizot-Martin
- Clinical Immunohaematology Service, Université Aix-Marseille, AP-HM Sainte-Marguerite, Marseille INSERM, U912 (SESSTIM), Marseille
| | - D Costagliola
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - F Boué
- Department of Internal Medicine and Immunology, Hôpital Antoine Béclère, Clamart Faculty of Medicine, Université Paris-Sud, Le Kremlin-Bicêtre
| | - O Rosmorduc
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Hepatology Service, Hôpital Saint-Antoine, Paris
| | - A Lavolé
- Pneumology Service, Hôpital Tenon, Paris
| | - S Choquet
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - P-E Heudel
- Medical Oncology Service, Centre Léon Bérard, Lyon
| | - V Leblond
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - J Gabarre
- Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - M-A Valantin
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - C Solas
- Laboratory of Pharmacokinetics and Toxicology, Hôpital de La Timone, Marseille
| | - A Guihot
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Immunology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - G Carcelain
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - B Autran
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - C Katlama
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - L Quéro
- Department of Oncology and Radiotherapy, Hôpital Saint Louis, Paris INSERM UMR_S 965, Université Paris Denis Diderot, Paris, France
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18
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Joshi D, Agarwal K. Role of liver transplantation in human immunodeficiency virus positive patients. World J Gastroenterol 2015; 21:12311-12321. [PMID: 26604639 PMCID: PMC4649115 DOI: 10.3748/wjg.v21.i43.12311] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/04/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
End-stage liver disease (ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus (HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus (HCV) infection, drug-induced hepatotoxicity related to combined anti-retro-viral therapy, alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore, anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However, HIV-HCV co-infection transplant outcomes remain suboptimal due to recurrence. In this article, we review the key challenges faced by this patient cohort in the pre- and post-transplant period.
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19
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Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F, Barelli A, Raise E. Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era. World J Virol 2015; 4:209-218. [PMID: 26279983 PMCID: PMC4534813 DOI: 10.5501/wjv.v4.i3.209] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.
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20
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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21
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Miro JM, Stock P, Teicher E, Duclos-Vallée JC, Terrault N, Rimola A. Outcome and management of HCV/HIV coinfection pre- and post-liver transplantation. A 2015 update. J Hepatol 2015; 62:701-11. [PMID: 25450714 DOI: 10.1016/j.jhep.2014.10.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 01/13/2023]
Abstract
Liver transplantation is increasingly performed in selected HIV-infected patients in most developed countries, with excellent results reported in patients with liver diseases unrelated to HCV. In contrast, survival in HCV/HIV-coinfected liver recipients is poorer than in HCV-monoinfected patients, due to more aggressive recurrence of HCV and consequent graft loss and death. Results from American, French, and Spanish cohort studies showed a 5-year survival rate of only 50-55%. Therefore, it is debated whether liver transplantation should be offered to HCV/HIV-coinfected patients. Studies have shown that the variables more consistently associated with poor outcome are: (1) the use of old or HCV-positive donors, (2) dual liver-kidney transplantation, (3) recipients with very low body mass index and (4) less site experience. However, the most effective factor influencing transplantation outcome is the successful treatment of HCV recurrence with anti-HCV. Survival is 80% in patients whose HCV infection resolves. Unfortunately, the rates of sustained virological response with pegylated-interferon plus ribavirin in coinfected recipients are low, particularly for genotype 1 (only 10%). Here we present a non-systematic review of the literature based on our own experience in different liver transplant scenarios. This review covers selection criteria in HIV-infected patients, pre- and post-LT management, donor selection, anti-HCV treatment, drug interactions with antiretrovirals and anti-HCV direct antiviral agents, hepatocellular carcinoma, and liver retransplantation. Recommendations are rated. Finally, we explain how the introduction of new effective and more tolerable direct antiviral agents may improve significantly the outcome of HCV/HIV-coinfected liver recipients.
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Affiliation(s)
- Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Peter Stock
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Elina Teicher
- Département Médecine Interne et Infectiologie, AP-HP Hôpital Kremlin Bicêtre, Le Kremlin Bicêtre, DHU Hepatinov, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpitaux de Paris, Centre Hépato-Biliaire, Univ. Paris-Sud, UMR-S 785, Inserm, Unité 785, DHU Hepatinov, Villejuif, France
| | - Norah Terrault
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Antoni Rimola
- Liver Unit, Hospital Clinic - IDIBAPS, CIBEREHD, Barcelona, Spain
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22
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Do the epidemiology, physiological mechanisms and characteristics of hepatocellular carcinoma in HIV-infected patients justify specific screening policies? AIDS 2014; 28:1379-91. [PMID: 24785953 DOI: 10.1097/qad.0000000000000300] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.
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Baccarani U, Righi E, Adani GL, Lorenzin D, Pasqualucci A, Bassetti M, Risaliti A. Pros and cons of liver transplantation in human immunodeficiency virus infected recipients. World J Gastroenterol 2014; 20:5353-5362. [PMID: 24833865 PMCID: PMC4017050 DOI: 10.3748/wjg.v20.i18.5353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/05/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients’ life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer “whether it is correct to transplant HIV-infected patients”, but “who are the patients who can be safely transplanted” and “when is the best time to perform LT”. Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients’ selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.
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Congly SE, Doucette KE, Coffin CS. Outcomes and management of viral hepatitis and human immunodeficiency virus co-infection in liver transplantation. World J Gastroenterol 2014; 20:414-424. [PMID: 24574710 PMCID: PMC3923016 DOI: 10.3748/wjg.v20.i2.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation for human immunodeficiency virus (HIV) positive patients with viral hepatitis co-infection is increasingly offered in many North American and European liver transplant centers. Prior studies have demonstrated acceptable post-transplant outcomes and no increased risk of HIV complications in patients co-infected with hepatitis B virus (HBV). However, liver transplantation in HIV positive patients with hepatitis C virus (HCV) has poorer outcomes overall, requiring careful selection of candidates. This review aims to summarize the published literature on outcomes after transplant in HIV patients with HBV or HCV related end-stage liver disease and recommendations for management. In particular the pre-transplant factors impacting outcomes in HCV/HIV co-infected candidates and importance of multidisciplinary management will be discussed.
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25
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Abstract
PURPOSE OF REVIEW The growing burden of non-AIDS defining malignancies (non-ADMs) among people living with HIV/AIDS (PLWHA) highlights the need for cancer prevention and early detection. In this article, we propose screening guidelines for non-ADMs in PLWHA. RECENT FINDINGS A number of recent findings may help direct cancer screening guidelines in PLWHA. Screening for lung cancer with low-dose helical chest computerized tomography (LDCT) in the National Lung Screening Trial data demonstrated a decrease in lung cancer and all-cause mortality. Recent studies have demonstrated a favorable experience among PLWHA with liver transplantation. Overdiagnosis is common with breast and prostate cancer screening. Anal cancer rates were substantially higher for HIV-infected MSM, other men and women than for HIV-uninfected individuals. SUMMARY Screening recommendations for the general population can be applied to PLWHA patients for breast, colon and prostate cancer. Screening for lung cancer with LDCT could be considered in PLWHA at risk. American Association for the Study of Liver Diseases screening recommendations with biennial ultrasonography may be applied to at-risk PLWHA for hepatocellular carcinoma. All HIV-infected adults should be offered anal cancer screening as part of clinical care at specialized centres.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Multicare Good Samaritan Hospital, Puyallup, WA, USA
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26
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Di Benedetto F, Tarantino G, Ercolani G, Baccarani U, Montalti R, De Ruvo N, Berretta M, Adani GL, Zanello M, Tavio M, Cautero N, Tirelli U, Pinna AD, Gerunda GE, Guaraldi G. Multicenter italian experience in liver transplantation for hepatocellular carcinoma in HIV-infected patients. Oncologist 2013; 18:592-9. [PMID: 23666950 DOI: 10.1634/theoncologist.2012-0255] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of our work is to assess the clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV-coinfected patients. This is a multicenter study involving three Italian transplant centers in northern Italy: University of Modena, University of Bologna, and University of Udine. PATIENTS AND METHODS We compared 30 HIV-positive patients affected by HCC who underwent LT with 125 HIV-uninfected patients who received the same treatment from September 2004 to June 2009. At listing, there were no differences between HIV-infected and -uninfected patients regarding HCC features. Patients outside the University of California, San Francisco criteria (UCSF) were considered eligible for LT if a down-staging program permitted a reduction of tumor burden. RESULTS HIV-infected patients were younger, they were more frequently anti-HCV positive, and a higher number of HIV-infected patients presented a coinfection HBV-HCV. Pre-LT treatments (liver resection and or locoregional treatments) were similar between the two groups. Histological characteristics of the tumor were similar in patients with and without HIV infection. No differences were observed in terms of overall survival and HCC recurrence rates. CONCLUSION LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post-LT outcome.
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Affiliation(s)
- Fabrizio Di Benedetto
- Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy.
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27
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Curry MP. HIV and hepatitis C virus: special concerns for patients with cirrhosis. J Infect Dis 2013; 207 Suppl 1:S40-4. [PMID: 23390304 DOI: 10.1093/infdis/jis763] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Since the advent of highly active antiretroviral therapy, liver disease has been a major cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Chronic viral hepatitis accounts for >80% of liver-related mortality. Liver-related morbidity is due to acceleration of hepatitis C virus (HCV) disease, drug-induced hepatotoxicity, and, possibly, direct damage from HIV infection itself. As a consequence of this complex interaction, end-stage liver disease and hepatocellular carcinoma are frequent complications in patients with HIV infection. Infectious diseases physicians who care for HIV-infected patients with advanced HCV-related liver disease need to know how to assess for advanced fibrosis, to know when to refer a patient for endoscopic screening for varices, and to enroll patients in a screening program for hepatocellular carcinoma.
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Affiliation(s)
- Michael P Curry
- Liver Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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28
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Quiles Granado AM, Laguillo Sala G, Gómez Roselló E, Remollo Friedemann S, Pedraza Gutiérrez S. [Spinal cord compression due to metastasis from a hepatocarcinoma in an human immunodeficiency virus-positive patient. A propos of a case]. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:437-8. [PMID: 23465581 DOI: 10.1016/j.gastrohep.2012.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 11/16/2022]
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29
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Blumberg EA, Rogers CC. Human immunodeficiency virus in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:169-78. [PMID: 23465009 DOI: 10.1111/ajt.12109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E A Blumberg
- Perelman School of Medicine of University of Pennyslvania, Philadelphia, PA, USA.
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30
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Standardized Care Management Ensures Similar Survival Rates in HIV-Positive and HIV-Negative Patients With Hepatocellular Carcinoma. J Acquir Immune Defic Syndr 2012; 61:581-7. [DOI: 10.1097/qai.0b013e31826ebdc7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Abstract
PURPOSE OF REVIEW The transplant community has seen the gradual acceptance of liver and kidney transplantation in carefully selected HIV-positive patients. The addition of transplant immunosuppressants to an already immunocompromised state, however, may increase the risk of malignancy. RECENT FINDINGS Kidney transplantation and liver transplantation have been successful in large series of carefully selected HIV-infected patients, with graft and patient survival approaching those of non-HIV-infected patients. The incidence of acute cellular rejection (kidney transplantation) and of recurrent hepatitis C (liver transplantation) remains challenging. Hepatocellular carcinoma (HCC), which is a common indication for liver transplantation, seems to occur at a younger age and to have a generally worse outcome in the HIV-positive patients. Liver transplantation outcomes for HCC in these patients, however, do not seem to be compromised. Rates of Kaposi's sarcoma and other de-novo malignancies such as skin cancer are relatively low after transplant. Kaposi's sarcoma may regress with the use of the mammalian target of rapamycin inhibitor sirolimus. In HIV-positive patients followed closely for human papilloma virus (HPV)-related anal neoplasia after transplantation, there may be an increased risk of progression to high-grade squamous intraepithelial lesions. SUMMARY The risk of recurrent or de-novo malignancy after solid-organ transplantation in HIV patients is low. HPV-related neoplasia, however, requires further study.
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32
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Lacombe K. Primary liver cancer among cirrhosis patients with and without HIV infection. Clin Res Hepatol Gastroenterol 2012; 36:193-4. [PMID: 22481088 DOI: 10.1016/j.clinre.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/14/2012] [Indexed: 02/04/2023]
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33
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Infections and organ transplantation: new challenges for prevention and treatment--a colloquium. Transplantation 2012; 93:S4-S39. [PMID: 22374265 DOI: 10.1097/tp.0b013e3182481347] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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34
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Abstract
Non-AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the screening test and its potential outcome. HIV-infected patients are at enhanced risk of several cancers compared to the general population; anal cancer, hepatocellular carcinoma, Hodgkin's lymphoma, and lung cancer all have good evidence demonstrating an enhanced risk in HIV-infected persons. A number of cancer screening interventions have shown benefit for specific cancers in the general population, but data on the application of these tests to HIV-infected persons are limited. Here we review the epidemiology and background literature relating to cancer screening interventions in HIV-infected persons. We then use these data to inform a conceptual model for evaluating HIV-infected patients for cancer screening.
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35
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Abstract
There is a paucity of information on the utilization patterns of liver transplantation (LT) for HIV-positive individuals. The aim of this study is to examine the trends in LT of HIV patients in the US. This study was a retrospective analysis using the UNOS database (1999-2008). There were 135 HIV-positive patients. There was a steady increase in the number of LT recipients over time as well as regional variation. Ethnic minorities accounted for 33.3% and there was no ethnic difference in survival. Though LT for HIV-positive patients is on the rise, significant variations exist in patient demographics, geographic location, and insurance payer.
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36
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37
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Baccarani U, Adani GL, Tavio M, Viale P. Liver transplantation for hepatocellular carcinoma: the impact of human immunodeficiency virus infection--21 plus 13. Hepatology 2011; 53:2138; author reply 2138-9. [PMID: 21391221 DOI: 10.1002/hep.24287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Umberto Baccarani
- Liver Transplant Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Gian Luigi Adani
- Liver Transplant Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Marcello Tavio
- Division of Infectious Disease, Ospedali Riuniti of Ancona, Ancona, Italy
| | - Pierluigi Viale
- Institute of Infectious Disease, University of Bologna, Bologna, Italy
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