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Epidemiology and outcome of infections in HIV/HCV-coinfected liver transplant recipients A FIPSE/GESIDA prospective cohort study

Epidemiology and outcome of infections in HIV/HCV-coinfected liver transplant recipients A FIPSE/GESIDA prospective cohort study

Information regarding non-AIDS-related infections in HIV-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcome of bacterial, viral, and fungal infections in HIV/HCV-coinfected OLT 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 22 and 26 and followed until December 29. Median age was 42 years and 78% were men. Median follow-up was 2.6 years (IQR, 1.25-3.53) and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) CMV infection (2 CMV disease), 13 (15%) herpes simplex virus infection, and 16 (19%) fungal infections (7 invasive cases). Nine patients (11%) developed 1 opportunistic infections with 44% mortality. Out of 119 infectious episodes, 43 (36%) occurred in the first month after transplantation and 53 (45%) after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 (43%) patients died, and death was related to severe infection in 7 (19%) cases. Severe infections increased mortality almost 3-fold (HR 2.9; 95%CI 1.5-5.8). Independent factors of severe infection included pretransplant MELD score >15 (HR 3.5; 95%CI 1.7-7.1), history of AIDS-defining events prior to transplantation (HR 2.5; 95%CI 1.5-5.1) and non-tacrolimus based immunosuppression (HR 2.5, 95% CI 1.3-4.8). HIV/HCV-coinfected liver recipients had a high rate of severe and opportunistic infections, especially in patients with previous AIDS, a high MELD score, and non tacrolimus-based immunosuppression.

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Accession: 036199646

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DOI: 10.1002/lt.22431

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