Improved Survival After Liver Transplantation for Patients With Human Immunodeficiency Virus (HIV) and HIV/Hepatitis C Virus Coinfection in the Integrase Strand Transfer Inhibitor and Direct-Acting Antiviral Eras

Authors

Jake Sheraj Jacob
Anjiya Shaikh
Karthik Goli
Nicole E Rich
Jihane N Benhammou
Aijaz Ahmed
Donghee Kim
Abbas Rana
John A Goss
Susanna Naggie
Tzu-Hao Lee
Fasiha Kanwal
George Cholankeril

Publication Date

2-18-2023

Journal

Clinical Infectious Diseases

DOI

10.1093/cid/ciac821

PMID

36221143

PMCID

PMC10169442

PubMedCentral® Posted Date

10-12-2022

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Adult, Humans, Liver Transplantation, Antiviral Agents, Hepacivirus, HIV, Retrospective Studies, Coinfection, Hepatitis C, Chronic, Hepatitis C, HIV Infections, Integrases, INSTI, DAA, transplant, HIV, HCV

Abstract

BACKGROUND: People with human immunodeficiency virus (HIV) with and without hepatitis C virus (HCV) coinfection had poor outcomes after liver transplant (LT). Integrase strand transfer inhibitors (INSTIs) and direct-acting antivirals (DAAs) have changed the treatment landscape for HIV and HCV, respectively, but their impact on LT outcomes remains unclear.

METHODS: This retrospective analysis of adults with HIV monoinfection (n = 246) and HIV/HCV coinfection (n = 286) who received LT compared mortality in patients with HIV who received LT before versus after approval of INSTIs and in patients with HIV/HCV coinfection who received LT before versus after approval of DAAs. In secondary analysis, we compared the outcomes in the different eras with those of propensity score-matched control cohorts of LT recipients without HIV or HCV infection.

RESULTS: LT recipients with HIV monoinfection did not experience a significant improvement in survival between the pre-INSTI and INSTI recipients with HIV (adjusted hazard ratio [aHR], 0.70 [95% confidence interval {CI}, .36-1.34]). However, recipients with HIV/HCV coinfection in the DAA era had a 47% reduction (aHR, 0.53 [95% CI, .31-9.2] in 1-year mortality compared with coinfected recipients in the pre-DAA era. Compared to recipients without HIV or HCV, HIV-monoinfected recipients had higher mortality during the pre-INSTI era, but survival was comparable between groups during the INSTI era. HIV/HCV-coinfected recipients also experienced comparable survival during the DAA era compared to recipients without HCV or HIV.

CONCLUSIONS: Post-LT survival for people with HIV monoinfection and HIV/HCV coinfection has improved with the introduction of INSTI and DAA therapy, suggesting that LT has become safer in these populations.