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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 18-1Suggested Inclusion Criteria for LT in HIV-Infected Individuals

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 ...

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