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[Liver transplantation in patients with HIV infection: a reality in 2004].
- Source :
-
Enfermedades infecciosas y microbiologia clinica [Enferm Infecc Microbiol Clin] 2004 Nov; Vol. 22 (9), pp. 529-38. - Publication Year :
- 2004
-
Abstract
- According to current estimates, there are 60,000 to 80,000 HIV and HCV coinfected individuals in Spain, and 5,000 to 10,000 HIV and HBV coinfected individuals. Among these patients, 10% to 15% have liver cirrhosis. Thus, end-stage liver disease is one of the major causes of death in our country. Liver transplantation is the only therapeutic option for these patients. Accumulated experience in North America and Europe in the last five years indicates that three-year survival in HIV-positive liver transplant recipients is similar to that of HIV-negative recipients. The selection criteria for HIV transplant candidates includes the following: no history of opportunistic infections, CD4 lymphocyte count higher than 100 cells/mm3, and HIV viral load suppressible with antiretroviral treatment. In Spain, where the majority of patients are former drug abusers, complete abstinence from heroin or cocaine use during two years is also required, with the possibility of the patient being in a methadone program. To date 26 hepatic transplants have been performed in the same number of patients, with only two deaths (7%) after a median follow-up of eight months (1-28). The main problems in the post-transplantation period in all the series has been recurrent HCV infection, which is the principle cause of post-transplantation mortality, and pharmacokinetic and pharmacodynamic interactions between the antiretroviral and immunosuppressive agents. There is little experience with pegylated interferon and ribavirin treatment in this population.
- Subjects :
- Anti-HIV Agents pharmacokinetics
Anti-HIV Agents therapeutic use
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Drug Interactions
Follow-Up Studies
HIV Infections drug therapy
Hepacivirus physiology
Hepatitis B virus physiology
Hepatitis B, Chronic complications
Hepatitis B, Chronic drug therapy
Hepatitis B, Chronic surgery
Hepatitis C, Chronic complications
Hepatitis C, Chronic drug therapy
Hepatitis C, Chronic surgery
Humans
Immunosuppressive Agents pharmacokinetics
Immunosuppressive Agents therapeutic use
Liver Cirrhosis etiology
Patient Selection
Postoperative Complications epidemiology
Postoperative Complications microbiology
Postoperative Complications virology
Spain epidemiology
Survival Rate
Viral Load
Virus Activation
Waiting Lists
HIV Infections complications
Liver Cirrhosis surgery
Liver Transplantation ethnology
Liver Transplantation statistics & numerical data
Subjects
Details
- Language :
- Spanish; Castilian
- ISSN :
- 0213-005X
- Volume :
- 22
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Enfermedades infecciosas y microbiologia clinica
- Publication Type :
- Academic Journal
- Accession number :
- 15511394
- Full Text :
- https://doi.org/10.1016/s0213-005x(04)73155-9