1 / 9

ORGAN TRANSPLANTATION: PERSONS WITH DETECTABLE HIV VIRAL LOAD

ORGAN TRANSPLANTATION: PERSONS WITH DETECTABLE HIV VIRAL LOAD Margaret Ragni, MD University of Pittsburgh . HIV/HCV Co-Infected Patients Greater HCV RNA, liver fibrosis, ESLD Increased hepatotoxicity, drug interactions

niel
Download Presentation

ORGAN TRANSPLANTATION: PERSONS WITH DETECTABLE HIV VIRAL LOAD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ORGAN TRANSPLANTATION: PERSONS WITH DETECTABLE HIV VIRAL LOAD Margaret Ragni, MD University of Pittsburgh

  2. HIV/HCV Co-Infected Patients Greater HCV RNA, liver fibrosis, ESLD • Increased hepatotoxicity, drug interactions • Reduced response to interferon/ribavirin • Reduced tolerance to HAART Thus, more likely to have detectable HIVviral load

  3. HIV Viral Load: A Spectrum 1. HIV Disease Progression  HIV RNA Disease Progression 2. HIV Transmission  HIV RNASexual transmission 3. Survival  HIV RNA Survival  Spectrum: Not Black and White

  4. HIV Viral Load: A Spectrum 1. HIV Disease Progression– AIM is undetectable HIV RNA REALITY is low set point slows progression (Mellors et al, Science, 1996) 2. HIV Sexual Transmission – AIM is undetectable HIV RNA REALITY is low set point reduce transmission (Ragni et al, JAIDS, 1998) 3. Survival– AIM is undetectable HIV RNA REALTY is low set point improves survival (Mellors et al, Ann Int Med, 1996)  Spectrum: Not Black and White

  5. LIVER TRANSPLANT in HIV: PITTSBURGH (1997-2001) Age//SexRisk GroupOLTXCD4HIV RNAHAARTSURVIVAL 1.38 yo WM Hemophilia 9/97 160 /l <400 3TC, d4T, Viracept 46 months HBV/HCV/HIV 2. 44 yo WM Bisexual 12/98 169 /l <50 3TC, d4T,Viracept 31 months HCV/HIV 3. 43 yo WM Hemophilia 1/99 155 /l 16,000 Combivir,Viracept 0.5 months HCV/HBV/HIV d. pancreatitis 4. 43 yo WM Hemophilia 3/99 62 /l <400 Combivir, Viracept 22 months HCV/HIV d. noncompli,rejex 5. 40 yo BF Heterosexual 5/00 103 /l 3,300 Combivir, Viracept 14 months AHN/Viramune/HIV 6. 52 yo WM IVDU 10/00 280 /l <400 3TC, ddC, Crixivan 9 months HBV/HCV/HIV 7. 33 yo WM Hemophilia 01/01 350 /l <400 Combivir, Viracept 6 months HCV/HBV/HIV Viramune (pre)

  6. RECOMMENDATIONS: OLTX Eligibility • Subjects with CD4 < 200/l • Subjects with detectable HIVviral load • Previously responsive to HAART • No longer able to tolerate HAART • Liver toxicity • Severe liver dysfunction • Drug interactions • Subjects with past opportunistic infections • Otherwise as above, once infection resolves

  7. Other Unanswered Questions 1. Optimal Time for OLTX 2. Optimal Antiretroviral, Antirejection Drugs 3. Recurrence of HCV Infection in Transplanted Organ

  8. Issues: Transplant in HIV Infection 1. Develop new treatment approaches for HCV 2. Determine risk factors for HCV progression 3. Determine risk factors for adverse outcome

  9. Issues: Transplant in HIV Infection 1. Develop new treatment approaches for HCV Antiviral, anti-cytokine, anti-fibrotic drugs 2. Determine risk factors for HCV progression ETOH, Hep B, HIV, Hepatotoxins 3. Determine risk factors for adverse outcome Pancreatitis, drug interactions, anti-rejection,antiretroviral drugs

More Related