Evaluation and outcomes of liver transplantation for hepatitis/hiv co-infection

An estimated 180 million people worldwide are infected with hepatitis C virus (HCV). HCV is the most common blood borne infection in the United States with a prevalence nearly 4 fold greater than human immunodeficiency virus (HIV). It is the leading cause of end stage liver disease, hepatocellular carcinoma and liver transplantations in the United States. Hepatitis B virus (HBV)) and HCV are common among patients with HIV because of shared routes of viral transmission. Due to successful highly active antiretroviral therapy, opportunistic infections and related complications from Acquired Immune Deficiency Syndrome (AIDS) are less common causes of mortality in HIV patients. However, endstage liver disease due to chronic HBV and HCV infection is becoming a leading cause of death among persons with HIV infection worldwide with the risk of death due to liver disease is inversely related to the CD4 cell count.There has been a strong debate recently about the need for aggressive evaluation of co-infected patients with end stage liver disease for liver transplantation. This chapter will review the outcomes of liver transplantation for co-infected patients, important drug interactions and briefly discuss the ethical issues related to this vulnerable population/.