Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients : a FIPSE/GESIDA prospective cohort study
Copyright © 2011 American Association for the Study of Liver Diseases..
Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range = 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) = 2.9, 95% confidence interval (CI) = 1.5-5.8]. Independent factors for severe infections included a pretransplant Model for End-Stage Liver Disease (MELD) score >15 (HR = 3.5, 95% CI = 1.70-7.1), a history of AIDS-defining events before transplantation (HR = 4.0, 95% CI = 1.9-8.6), and non-tacrolimus-based immunosuppression (HR = 2.5, 95% CI = 1.3-4.8). In conclusion, the rates of severe and opportunistic infections are high in HIV/HCV-coinfected liver recipients and especially in those with a history of AIDS, a high MELD score, or non-tacrolimus-based immunosuppression.
| Errataetall: |
CommentIn: Liver Transpl. 2012 Mar;18(3):376-7; author reply 378-9. - PMID 22162205 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2012 |
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| Erschienen: |
2012 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society - 18(2012), 1 vom: 24. Jan., Seite 70-81 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Moreno, Asunción [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 24.04.2012 Date Revised 22.12.2011 published: Print CommentIn: Liver Transpl. 2012 Mar;18(3):376-7; author reply 378-9. - PMID 22162205 Citation Status MEDLINE |
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| doi: |
10.1002/lt.22431 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM211290297 |
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| 100 | 1 | |a Moreno, Asunción |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients |b a FIPSE/GESIDA prospective cohort study |
| 264 | 1 | |c 2012 | |
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| 500 | |a Date Completed 24.04.2012 | ||
| 500 | |a Date Revised 22.12.2011 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Liver Transpl. 2012 Mar;18(3):376-7; author reply 378-9. - PMID 22162205 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2011 American Association for the Study of Liver Diseases. | ||
| 520 | |a Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range = 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) = 2.9, 95% confidence interval (CI) = 1.5-5.8]. Independent factors for severe infections included a pretransplant Model for End-Stage Liver Disease (MELD) score >15 (HR = 3.5, 95% CI = 1.70-7.1), a history of AIDS-defining events before transplantation (HR = 4.0, 95% CI = 1.9-8.6), and non-tacrolimus-based immunosuppression (HR = 2.5, 95% CI = 1.3-4.8). In conclusion, the rates of severe and opportunistic infections are high in HIV/HCV-coinfected liver recipients and especially in those with a history of AIDS, a high MELD score, or non-tacrolimus-based immunosuppression | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Cervera, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Fortún, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Blanes, Marino |e verfasserin |4 aut | |
| 700 | 1 | |a Montejo, Estibalitz |e verfasserin |4 aut | |
| 700 | 1 | |a Abradelo, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Len, Oscar |e verfasserin |4 aut | |
| 700 | 1 | |a Rafecas, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Martín-Davila, Pilar |e verfasserin |4 aut | |
| 700 | 1 | |a Torre-Cisneros, Julián |e verfasserin |4 aut | |
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| 700 | 1 | |a Miró, José M |e verfasserin |4 aut | |
| 700 | 0 | |a OLT-HIV FIPSE Cohort Investigators |e verfasserin |4 aut | |
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