Role of liver transplantation in human immunodeficiency virus positive patients

Table 1 Drug-drug interactions between directly acting anti-hepatitis C virus directly acting antiviral and combined anti-viral therapy

Anti-HCV DAA	cART not recommended	Dose changes
Boceprevir	Atazanavir
	Darunavir/ritonavir
	Efavirenz
	Ritonavir
Telaprevir	Darunavir	Efavirenz - dose increased
	Lopinavir/ritonavir	to 1125 mg TDS
Simeprevir	Atazanavir
	Efavirenz
	Darunavir/ritonavir
	Nevirapine
Daclatasvir	-	Efavirenz - dose increased to 90 mg OD
		Atazanavir and protease inhibitors - dose reduced to 30 mg OD
Sofosbuvir	Didanosine
	Zidovudine

DAA: Directly acting antiviral; cART: Combined anti-viral therapy; HCV: Hepatitis C virus.

Table 2 Criteria for liver transplantation in human immunodeficiency virus-positive individuals

The criteria for liver transplantation are met
CD4+ cell count > 100 cells/μL (> 200 cells/μL with a previous history of opportunistic complications)
HIV viral load < 50 copies/mL (using ultrasensitive Amplicor Monitor PCR assay)
Absence of AIDS-defining illness1
Absence progressive multi-focal leukoencephalopathy, chronic intestinal cryptosporidiosis (> 1 mo) or primary CNS lymphoma

¹None after combined anti-viral therapy-induced immune reconstitution. CNS: Central nervous system; AIDS: Acquired immune deficiency syndrome; HIV: Human immunodeficiency virus.

Table 3 Prospective studies conducted in human immunodeficiency virus/hepatitis C virus co-infected patients undergoing liver transplantation

	n	Patient survival	Incidence of ACR	Risk factors for death amongst HIV/HCV recipients1
Miro et al[65], 2012	HIV/HCV - 84	1, 3, 5 yr: 88%, 62%, 54%	38%	HCV G1
	HCV - 252	1, 3, 5 yr: 90%, 76%, 71%1	20%1	Donor risk index
				MELD score
				Center < 1 transplant/yr2
Terrault et al[66], 2012	HIV/HCV - 89	1 and 3 yr: 92% and 79%	39%	Combined liver-kidney transplant
	HCV - 235	1 and 3 yr: 76% and 60%1	24%1	BMI < 21
				Anti-HCV positive donor
				Older donor

¹Statistically significant (P < 0.05);

²Less than one liver transplant per year in a human immunodeficiency virus (HIV)-infected patient. HCV: Hepatitis C virus; BMI: Body mass index; ACR: Acute cellular rejection.

Table 4 Antiretroviral medications and their effect on calcineurin inhibitors

Drug	Effect on CNI level
Protease inhibitor
Darunavir	↑↑
Fosamprenavir	↑↑
Lopinavir	↑↑
Ritonavir	↑↑↑
Saquinavir	↑↑
Non nucleoside reverse transverse inhibitors
Efavirenz	↓↓
Nevirapine	↓↓
Integrase inhibitors
Raltegravir	No effect

CNI: Calcineurin inhibitors.