Review: Evaluation and Management of the HIV/HCV Co-Infected Kidney or Liver Transplant Candidate

AbstractPurpose of reviewUntil recently, human immunodeficiency virus (HIV) was considered a contraindication to solid organ transplant (SOT) as there were concerns about poor outcomes given the high degree of immunosuppression needed to successfully transplant and retain an allograft. Emerging data has shown positive outcomes in HIV-infected solid organ transplants but a less well-explored area in the literature is SOT in those co-infected with HIV and hepatitis C virus (HCV). Kidney and liver transplantation remain the focus of this review as data on outcomes from other organs remains largely limited to case series and opinions. Similar to HIV, HCV infection was traditionally thought to confer poorer outcomes in solid organ transplant based on studies during the interferon era of treatment. With the advent of direct-acting antivirals (DAAs), excellent outcomes have been achieved in HCV-positive organ transplant recipients. This review is intended to evaluate current evidence regarding best practices for solid organ transplant in individuals co-infected with HCV and HIV.Recent findingsThere have been several small trials that have looked at outcomes in SOT recipients with HIV/HCV co-infection treated with DAAs. These studies achieved rates of sustained virologic response (SVR) similar to those in mono-infected recipients. Whether it is optimal to treat HCV before or after transplant remains elusive as treating after transplant may shorten time on the transplant list.SummaryT...
Source: Current Treatment Options in Infectious Diseases - Category: Infectious Diseases Source Type: research