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. 2023 Feb 18;76(4):592-599.
doi: 10.1093/cid/ciac821.

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

Jake Sheraj Jacob  1 , Anjiya Shaikh  2 , Karthik Goli  1 , Nicole E Rich  3 , Jihane N Benhammou  4 , Aijaz Ahmed  5 , Donghee Kim  5 , Abbas Rana  6 , John A Goss  6 , Susanna Naggie  7 , Tzu-Hao Lee  1   6 , Fasiha Kanwal  1 , George Cholankeril  1   6
Affiliations

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

Jake Sheraj Jacob et al. Clin Infect Dis. .

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.

Keywords: DAA; HCV; HIV; INSTI; transplant.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Cumulative mortality in the pre–integrase strand transfer inhibitor (INSTI) (A) and INSTI eras (B). Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus; HR, hazard ratio; INSTI, integrase strand transfer inhibitor.
Figure 2.
Figure 2.
Cumulative mortality in the pre–direct-acting antiviral (DAA) (A) and DAA eras (B). Abbreviations: CI, confidence interval; DAA, direct-acting antiviral; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HR, hazard ratio.
Figure 3.
Figure 3.
Cumulative mortality in the pre–direct-acting antiviral (DAA) (A) and DAA eras (B). Abbreviations: CI, confidence interval; DAA, direct-acting antiviral; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HR, hazard ratio.
Figure 4.
Figure 4.
Cumulative mortality in the pre–integrase strand transfer inhibitor (INSTI) (A) and INSTI eras (B). Abbreviations: CI, confidence interval; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HR, hazard ratio; INSTI, integrase strand transfer inhibitor.
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