Twin pregnancy in a liver transplant recipient with HIV infection

Abstract

We are not aware of a report detailing the complex obstetrical and medical management of twin pregnancy in the context of HIV infection and early post-liver transplantation period. Here we describe the successful outcome of a twin pregnancy in a 28-year-old HIV-positive female receiving antiretroviral therapy and immunosuppressive therapy who was the recipient of a liver transplant for previous drug-induced liver failure.

Keywords: HIV; liver function tests; liver transplantation; pregnancy; twin.

Figure 1.

Liver enzymes (LFTs) and function (INR) measured over the timeline of patient management: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured during times of patient admission and in the outpatient setting. Marked derangement in LFTs and INR was observed at the time of liver transplantation. At conception, LFTs and INR were normal. During the first trimester a rise in LFTs was present although INR remained normal throughout pregnancy. A liver biopsy was performed during the period of LFTs derangement. Caesarean section was performed at gestational age of 35 weeks+0 days

Figure 2.

HIV viral load and CD4 cell count measured over the timeline of patient management: HIV viral load (A) and CD4 count (B) were monitored periodically from the time of patient transfer. The patient's HIV infection remained well controlled throughout pregnancy