People with HIV – most of whom had hepatitis B
or C co-infection – generally had good outcomes after liver transplantation due
to hepatocellular carcinoma (HCC), with five-year survival rates similar to
those of HIV-negative transplant recipients and better than those of people who
underwent other types of liver cancer treatment, researchers reported this week
at the American Association for the Study of Liver Diseases (AASLD) Liver Meeting in Boston, USA.
People living with HIV often have hepatitis B
virus (HBV) or hepatitis C virus (HCV) co-infection and tend to
rapid liver disease progression. Traditionally, people living with HIV
were not considered good candidates for liver transplants due to concern
that immunosuppressant drugs used to prevent organ rejection might
HIV-related immune suppression and interact with antiretroviral
With improvements in antiretroviral therapy and a move to earlier
however, many people with HIV are in overall good health with
Heather Platt from Columbia University
Medical Center and colleagues performed a retrospective analysis of orthotopic liver
transplantation among people living with HIV who had HCC, a type of liver
cancer that can occur in people with chronic viral hepatitis, especially those
who progress to cirrhosis.
- hepatocellular carcinoma (HCC)
Liver cancer. A long-term complication of chronic inflammation of the liver or cirrhosis.
The researchers identified 367 people with HIV
treated for HCC at 43 centres in North and South America, Europe and Australia between 1995 and 2004. Among these, 27
received liver transplants and 108 underwent other types of potentially
curative therapy including surgical resection or tumour removal (51 people),
radiofrequency ablation (45 people) and percutaneous ethanol injection (12 people).
People who received transplants were slightly younger and had more
advanced liver dysfunction with higher Child-Turcotte-Pugh scores than those
receiving other types of treatment. However, their causes of liver disease were
similar, most commonly HCV infection (78%) or HBV infection (21%). People in
the different treatment groups had similar liver cancer staging (around 70%
with BCLC stages A or B), but transplant recipients more often had multiple
Across treatments, most people had well-controlled HIV disease with more
than 80% having undetectable HIV RNA. Median CD4 cell counts were approximately
300 cells/mm3 for transplant recipients and 400 cells/mm3
for those receiving other treatments.
The five-year survival rate was significantly higher for people who
received liver transplants (85%) compared to those undergoing other types of
treatment (52% combined). The five-year survival rate continued to be higher
for transplant recipients compared to other treatments when the analysis was
restricted to people with BCLC stage A.
Among transplant recipients, five-year survival was higher for people
with early (BCLC stage A and B) compared with late (BCLC stage C and D) liver
cancer, 89% vs 67%, respectively.
"For HIV-infected patients with HCC, orthotopic liver
transplantation is a therapeutic option with high survival rates which are
superior to radiofrequency ablation and surgical resection," the
They added that the five-year survival rate of 85% "compares favourably"
to reported survival rates of 75% to 80% for HIV-negative people with HCC
undergoing liver transplants.
"The primary point of this study is to show that
HIV-positive patients with HCC should be included in evaluation for orthotopic liver
transplantation, as there does not seem to be any
difference in survival when compared to HIV-negative patients," Heather Platt
stated in an AASLD
press release. "Importantly, the
survival data, while retrospective, does indicate a benefit compared to other
Addressing barriers to transplantation for people
living with HIV, Platt added that the main barriers include a centre's
experience and comfort with doing transplants for people with HIV. "HIV-positive
patients are examined quite carefully for compliance and for anticipation of
post-transplant complications," she said. "This requires a
comprehensive, multidisciplinary transplant program including specialists in
Speaking at the Liver Meeting's opening press conference, AASLD president
Adrian Di Bisceglie – who selected this study as one of a dozen conference
highlights – indicated that the improvement in transplant outcomes for people
with HIV is likely attributable to better understanding of which HIV-positive
patients are good candidates, namely those who are not already highly