Death from
end-stage liver disease (ESLD) because of
chronic hepatitis B and C has become an increasing problem in human immunodeficiency virus (HIV)-infected patients in the last years. This is mainly because of the dramatic decrease of HIV-related morbidity and mortality since the introduction of
highly active antiretroviral therapy (
HAART). Although the data on the outcome of
liver transplantation in HIV-infected recipients with ESLD is limited, overall results seem comparable to non-HIV-infected recipients. Therefore,
liver transplant centres around the world are increasingly accepting HIV-infected individuals as organ recipients. Post-
transplantation control of HIV replication is achieved by continuing
HAART. As in non-HIV-infected patients, hepatitis B virus recurrence is efficiently prevented by
hepatitis B immunoglobulin and
antiviral therapy.
Re-infection of the allograft with hepatitis C virus, however, remains an important problem, and progress to allograft
cirrhosis may even be more rapid than in HIV-negative patients. Interactions in drug metabolism between the
HAART components and the immunosuppressive drugs are difficult to predict and require close monitoring of drug levels and dose adjustments. The complexity in this setting makes close cooperation between transplant surgeons, hepatologists, HIV-clinicians and pharmacologists mandatory. As experience on
liver transplantation in HIV-infected individuals is still limited, to date results from large prospective trials addressing key issues are needed.