Improvements in Liver Transplantation Outcomes in Patients with Hepatitis C Virus/HIV Coinfection after the Introduction of Direct-Acting Antiviral Therapies
Shimada S, Kitajima T, Shamaa T, Ivanics T, Collins KM, Rizzari MD, Yoshida A, Abouljoud MS, Lu M, and Nagai S. Improvements in Liver Transplantation Outcomes in Patients with Hepatitis C Virus/HIV Coinfection after the Introduction of Direct-Acting Antiviral Therapies. J Am Coll Surg 2021; 233(5):S271-S272.
J Am Coll Surg
Introduction: Although liver transplantation (LT) outcomes in patients with hepatitis C virus (HCV) infection have improved after the introduction of direct-acting antivirals (DAAs), their impact on patients with HCV/HIV coinfection has not been evaluated. We aimed to assess the effects of DAAs on post-LT outcomes in patients with HCV/HIV compared with those with HIV or HCV mono-infection.
Methods: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing data, we compared post-LT graft survival in patients with HCV and/or HIV before and after DAAs introduction. Patients were classified into the following eras: era 1 (2008-2012 [pre-DAAs]) and era 2 (2014-2019 [post-DAAs]). Patients who received transplants in 2013 were excluded to allow a washout period of the effect of DAAs. Inverse probability weighting was used to adjust characteristic differences between eras. Analyses considered possible infection by era interactions.
Results: A total of 18,053 LT recipients were identified (HCV/HIV [n = 160]; HCV mono-infection [n = 17,705]; HIV mono-infection [n = 188]). In era 1, the 1-year graft survival rate in the coinfection group was significantly worse than in HCV and HIV mono-infection groups, but no difference was detected in era 2 (Fig. 1). Both HCV/HIV and HCV mono-infection had significant reduction on year-1 graft loss, compared with era 1; hazard ratio 0.25 (95% CI, 0.14 to 0.43) for HIV/HCV and hazard ratio 0.61 (95% CI, 0.57 to 0.65) for HCV (Table 1). Improvement was more prominent in the coinfection group. There was no significant change in patients with HIV mono-infection.
Conclusion: After the introduction of DAAs, more significant improvements in post-LT outcomes were observed in patients with coinfection compared with those with HIV or HCV mono-infection.