Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ With the introduction of combined antiretroviral therapy (cART), human immunodeficiency virus (HIV) is now considered a chronic illness and no longer considered an absolute contraindication to liver transplantation (LT).1 As HIV-infected patients live longer, liver transplantation is a reasonable option in those with advanced liver disease in the ART era. Multiple studies have shown promising results in ART-treated patients with suppressed HIV RNA, stable CD4 counts, and no significant increase in opportunistic infections after LT. See Table 18-1 for a generally accepted description for stable disease.2 ++Table Graphic Jump LocationTABLE 18-1Suggested Inclusion Criteria for LT in HIV-Infected IndividualsView Table||Download (.pdf) TABLE 18-1 Suggested Inclusion Criteria for LT in HIV-Infected Individuals CD4 cell count > 100 cells/µL without history of opportunistic infections CD4 cell count > 200 cells/µL during 3 months prior to LT if history of opportunistic infections or AIDS-defining malignancies Undetectable HIV viral load in blood for patients on C-ART If detectable viral load due to intolerance of C-ART, previous documentation of efficacious therapy or genotype/phenotypic resistance test documenting available post-LT C-ART options Compliance to a stable C-ART, and appropriate follow-up visits with providers experienced in the HIV management No active (less than 1 year) opportunistic infections, no wasting syndrome or severe malnutrition Ready access to therapeutic drug monitoring of immunosuppressive regimen There is no history of progressive multifocal leukoencephalopathy, chronic intestinal cryptosporidiosis (greater than 1 month duration), lymphoma or other neoplasm unless an adequate disease-free period is documenteda LT: Liver transplantation, C-ART: Combined antiretroviral therapy; HIV: Human Immunodeficiency virus.Most centers refer to the criteria set by the American Society of Transplantation (AST). There can be slight differences in the criteria due to center-specific guidelines as well as differences in the criteria between the U.S. and Europe.Data from recent guidelines from AST Infectious Diseases Community of Diseases and a review article by Baccarani et al. Blumberg EA, Rogers CC. Solid organ transplantation in the HIV-infected patient: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019;33(9). Baccarani U, Righi E, Adani GL, et al. Pros and cons of liver transplantation in human immunodeficiency virus infected recipients. World J Gastroenterol. 2014;20(18):5353-5362.aCriterion abstracted from the review article by Baccarani, et al only. +++ PRETRANSPLANTATION EVALUATION ++ Careful selection of HIV-infected patients to receive LT is important to ensure safety. Eligibility criteria for LT in HIV-infected patients are evolving to carefully select those with relatively intact immune systems and successfully suppressed viral load.1,3,4 Selection criteria for LT in HIV-positive individuals are listed in Table 18-1. HIV-infected patients have significantly shorter survival compared with HIV-negative patients. HIV-infected patients should be listed and transplanted as soon as possible, given a poor outcome while on the waiting list.3 HIV/hepatitis C virus (HCV) coinfected patients should be referred for LT after the first episode of decompensated cirrhosis.5... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth