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

被引:70
作者
Coffin, C. S. [1 ]
Stock, P. G. [2 ]
Dove, L. M. [3 ]
Berg, C. L. [4 ]
Nissen, N. N. [5 ]
Curry, M. P. [6 ]
Ragni, M. [7 ]
Regenstein, F. G. [8 ]
Sherman, K. E. [9 ]
Roland, M. E. [1 ]
Terrault, N. A. [1 ,2 ]
机构
[1] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Surg, San Francisco, CA 94143 USA
[3] Columbia Univ, Dept Med, New York, NY USA
[4] Univ Virginia, Dept Med, Charlottesville, VA USA
[5] Cedars Sinai, Dept Surg, Los Angeles, CA USA
[6] Harvard Univ, Sch Med, Dept Med, Boston, MA USA
[7] Univ Pittsburgh, Dept Med, Pittsburgh, PA USA
[8] Tulane Univ, Dept Med, New Orleans, LA 70118 USA
[9] Univ Cincinnati, Dept Med, Cincinnati, OH 45221 USA
关键词
Hepatitis B virus (HBV); hepatitis B immunoglobulin; immune deficiency; surface (S) gene; polymerase chain reaction; posttransplant; posttransplant complications; posttransplant mortality; ORTHOTOPIC LIVER-TRANSPLANTATION; OCCULT; DNA; PERSISTENCE; ANTIGEN; HCV; REPLICATION; MANAGEMENT; RESISTANCE; THERAPY;
D O I
10.1111/j.1600-6143.2010.03070.x
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Liver transplantation (LT) is the treatment of choice for end-stage liver disease, but is controversial in patients with human immunodeficiency virus (HIV) infection. Using a prospective cohort of HIV-hepatitis B virus (HBV) coinfected patients transplanted between 2001-2007; outcomes including survival and HBV clinical recurrence were determined. Twenty-two coinfected patients underwent LT; 45% had detectable HBV DNA pre-LT and 72% were receiving anti-HBV drugs with efficacy against lamivudine-resistant HBV. Post-LT, all patients received hepatitis B immune globulin (HBIG) plus nucleos(t)ide analogues and remained HBsAg negative without clinical evidence of HBV recurrence, with a median follow-up 3.5 years. Low-level HBV viremia (median 108 IU/mL, range 9-789) was intermittently detected in 7/13 but not associated with HBsAg detection or ALT elevation. Compared with 20 HBV monoinfected patients on similar HBV prophylaxis and median follow-up of 4.0 years, patient and graft survival were similar: 100% versus 85% in HBV mono- versus coinfected patients (p = 0.08, log rank test). LT is effective for HIV-HBV coinfected patients with complications of cirrhosis, including those who are HBV DNA positive at the time of LT. Combination HBIG and antivirals is effective as prophylaxis with no clinical evidence of HBV recurrence but low-level HBV DNA is detectable in similar to 50% of recipients.
引用
收藏
页码:1268 / 1275
页数:8
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