People coinfected with both the hepatitis B virus (HBV) and HIV have excellent survival rates following a liver transplant, according to a study published in the June 1 issue of AIDS.

HBV can become a chronic disease in roughly 25 percent of people who are also infected with HIV. When this occurs, people are at increased risk of liver failure and liver cancer, usually many years after first becoming infected. HBV disease, however, progresses more rapidly in coinfected people than in people not infected with HIV.

Moreover, when people develop end-stage liver disease, the only recourse is a liver transplant. For many years, people with HIV weren’t even considered viable candidates for a transplant. After it became clear that antiretroviral (ARV) therapy was significantly extending the survival of people with HIV, however, advocates successfully lobbied for coinfected people to be transplant candidates. Unfortunately, few studies have been published on the outcomes of liver transplant in coinfected people.

To determine the success of liver transplants in this population, Mariagrazia Tateo, MD, PhD, from the University of Bari, in Italy, and her colleagues examined the outcomes of transplants in 75 people living with HIV performed at the Hôpital Paul Brousse, Centre Hepato-Biliaire, in Paris. Thirteen of the patients were coinfected with HIV and HBV. Six were additionally infected with hepatitis C virus (HCV) as well as HIV and HBV. The average age of the patients was 46, and all had their HIV well controlled with ARV drugs.

People were followed, on average, for 32 months after their liver transplant. Survival over this time period was 100 percent. Ten of the HIV-positive patients had no rejection of their new livers. Three had mild to moderate rejection, which was ultimately overcome with changes to their immunosuppressive drugs used to prevent rejection.

Two HIV-positive patients had a recurrence of their HCV infection, but none had a recurrence of their HBV infection. Liver damage from the HCV recurrences, as well as damage to the energy-producing mitochondria of liver cells, was not evident in any of the HIV-positive patients studied.

“Our series thus demonstrate excellent results in terms of survival and the control of HBV replication following liver transplantation in HIV/HBV-coinfected patients,” the authors concluded.