{"id":761,"date":"2012-06-01T00:00:27","date_gmt":"2012-06-01T07:00:27","guid":{"rendered":"http:\/\/rhochistj.org\/RCP_TEST\/?p=761"},"modified":"2014-02-17T16:26:25","modified_gmt":"2014-02-17T23:26:25","slug":"transplantation-hiv-hbvhcv-patients","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/transplantation-hiv-hbvhcv-patients\/","title":{"rendered":"Transplantation in HIV +\/- HBV\/HCV Patients"},"content":{"rendered":"

By: Jayoung Park, Pharm.D. Candidate c\/o 2013<\/span><\/p>\n

–<\/p>\n

Traditionally, human immunodeficiency virus (HIV)-infected patients have generally been excluded from organ transplantation.1<\/sup>\u00a0 One of the principal concerns was that immunosuppression would accelerate HIV\/acquired immune deficiency syndrome (AIDS), resulting in increased mortality and a \u201cwaste\u201d of organs.1<\/sup><\/p>\n

A study entitled, \u201cOpportunistic Infections and Neoplasms Following Liver and Kidney Transplantation in the HIV infected Recipient,\u201d was presented at the 13th<\/sup> International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) held by the National Institute of Health (NIH).1<\/sup>\u00a0 It stated that although HIV does not progress in HIV-positive transplant recipients, there is a much higher incidence of organ rejection.1<\/sup>\u00a0 As Peter Stock, MD, PhD, professor of surgery at the University of California at San Francisco reported, such two to threefold higher incidences of organ rejection in HIV-positive patients than in HIV-negative patients indicated the presence of a very dysregulated immune system rather than an absence of immunity.1<\/sup><\/p>\n

An NIH-funded multicenter trial evaluated the effect of HIV infection on graft function and survival, as well as the effects of transplantation and post-transplant immunosuppression on HIV progression and markers of immune function\/activity.2<\/sup>\u00a0 There were 150 kidney and 125 liver transplants at 18 centers across the United States who received three to four years of follow-up.2<\/sup> \u00a0Patients selected for the study had CD4+ T-cell counts greater than 200 cells\/mm3<\/sup> in kidney recipients and greater than 100 cells\/mm3<\/sup> in liver recipients.2<\/sup> \u00a0Of the 150 kidney transplant recipients, 20% were co-infected with hepatitis C virus (HCV) at baseline.2<\/sup> The median follow-up was 3.6 years.2<\/sup> \u00a0Roughly 25% of patients had a history of opportunistic infections before transplantation.2<\/sup> \u00a0Among the 125 liver transplant recipients, 69% at baseline were co-infected with HCV, and the median duration of follow-up was four years.2<\/sup><\/p>\n

For the 150 kidney transplant recipients, researchers reported that HIV generally remained suppressed and CD4+ counts remained relatively stable.2<\/sup>\u00a0 When given antithymocyte globulin (ATG), the patients\u2019 CD4+ counts were depleted for one year; yet, there were minimal opportunistic infections during the time that it took for their CD4+ counts to increase again.2<\/sup> \u00a0The investigators did see a higher incidence of serious bacterial infections, about twofold greater, in the patients whose CD4+ counts were depleted.2<\/sup> \u00a0Both patient and graft survival were similar to that in the general population at one and three years.2<\/sup><\/p>\n

This high incidence of organ rejection in HIV-infected patients in an absence of HIV disease progression leads to an interesting message.2<\/sup>\u00a0 It seems that HIV is not the issue, but rather, the presence of a very dysregulated immune system could be more responsible.2<\/sup>\u00a0 Research is underway to explore the mechanism behind the high rate of rejection.2<\/sup><\/p>\n

Other observations worth attention are the differences in graft survival in HIV patients co-infected with Hepatitis B virus (HBV) or HCV compared with the mono-infected controls.3<\/sup> \u00a0Graft survival in co-infected patients at three years was 59%, while it was 67% in the mono-infected controls.3<\/sup> \u00a0Compared with patients mono-infected with HBV, HIV-positive liver transplant recipients co-infected with HBV did just as well with their transplants for five years, supporting the belief that HIV is not the problem but rather the co-pathogens are.3<\/sup><\/p>\n

However, the three-year survival rate in the HIV-HCV co-infected patients was a different story; it was 11% higher than with patients mono-infected with HCV.3<\/sup> \u00a0Also, the incidence of organ rejection in the HIV-HCV co-infected patients was twofold higher than that of HIV-HBV co-infected patients.3<\/sup> \u00a0Organ transplantations for co-infected patients with HCV (and not much for those with HBV) are opposed in many centers due to the low survival rates.3<\/sup><\/p>\n

As Dr. Stock stated, treating rejections creates another dilemma, as rejection becomes an independent predictor of graft loss and severe HCV recurrence (where control over the virus and the co-pathogen is lost when these patients are immunosuppressed).1<\/sup> \u00a0There has been no evidence of significant HIV disease progression on allograft function.1<\/sup> \u00a0A high incidence of organ rejection is a concern in kidney transplant recipients, as is the possible poor clinical outcome in HCV-co-infected liver transplant recipients.1<\/sup>\u00a0 The data observed in the trial indicated that transplantation should not be absolutely excluded as a treatment option for patients with well-controlled HIV disease, whereas its practice is opposed in patients co-infected with HBV or HCV.1<\/sup><\/p>\n

The mechanisms behind the high rate of rejection in HIV-positive patients require further studies.\u00a0 In addition, the association between the current treatments for treating these viruses and the risk of cancer may be another valuable topic for further investigation.<\/p>\n

SOURCES:<\/span><\/b><\/p>\n

    \n
  1. Capital Consulting Corporation. 13th<\/sup> International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Draft Agenda. Website. Available online: http:\/\/www.capconcorp.com\/meeting\/2011\/13thICMAOI\/agenda.asp.<\/a> \u00a0Nov 7, 2011. \u00a0Accessed Apr 10, 2012.<\/li>\n
  2. Yin S. No HIV Disease Progression in Transplant Recipients. Website. Available online: http:\/\/www.medscape.com\/viewarticle\/753922<\/a>. Nov 11, 2011. Accessed Apr 10, 2012.<\/li>\n
  3. Lie D. Co-infections and Co-therapies: Treatment of HIV in the Presence of\u00a0 Hepatitis C and Hepatitis B. Website. Available online: http:\/\/www.medscape.org\/viewarticle\/588909<\/a>. Nov 11, 2011. Accessed Apr 10, 2012.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By: Jayoung Park, Pharm.D. Candidate c\/o 2013 – Traditionally, human immunodeficiency virus (HIV)-infected patients have generally been excluded from organ transplantation.1\u00a0 One of the principal concerns was that immunosuppression would accelerate HIV\/acquired immune deficiency syndrome (AIDS), resulting in increased mortality and a \u201cwaste\u201d of organs.1 A study entitled, \u201cOpportunistic Infections and Neoplasms Following Liver and…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,4],"tags":[2237,343,40,1160,2241,15,2227,314,1110,20,18,2233,2247,23,376,2280,2281,137,2235,2236,363,968,1625,45,19,167,184,31,36,21,149,453,16,17,48,1061],"class_list":["post-761","post","type-post","status-publish","format-standard","hentry","category-clinical","category-featured","tag-aids","tag-and","tag-cancer","tag-control","tag-deficiency","tag-disease","tag-ebola-virus-disease","tag-for","tag-globulin","tag-health","tag-hepatitis","tag-hepatitis-b","tag-hepatitis-c","tag-hiv","tag-human","tag-human-immunodeficiency-virus","tag-immunodeficiency","tag-infection","tag-kidney","tag-liver","tag-of","tag-one","tag-or","tag-organ","tag-patient","tag-poor","tag-problem","tag-research","tag-risk","tag-study","tag-syndrome","tag-system","tag-treatment","tag-trial","tag-virus","tag-with"],"views":615,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=761"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/761\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=761"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}