Inserm, UMRS-945 Laboratoire d'Immunologie Cellulaire et Tissulaire, Centre Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'hôpital, Bâtiment CERVI, 75013 Paris, France.
J Hepatol. 2009 Dec;51(6):1000-9. doi: 10.1016/j.jhep.2009.06.031. Epub 2009 Sep 12.
BACKGROUND/AIMS: Liver transplantation (LT) in immune-suppressed human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfected patients is feasible but raises questions regarding the severity of HCV recurrence on the liver graft and preservation of immune function. We investigated whether LT is deleterious to the immune system.
Fourteen HIV-HCV coinfected patients (HIV viral load [VL] <50 copies/ml; median CD4 count of 276/mm(3) pretransplantation) were grafted for HCV-cirrhosis and followed over 2 years. Nine patients received anti-HCV therapy post-transplantation. HCV and HIV VLs and degree of acute and chronic hepatitis were monitored. Peripheral blood T-cell phenotypes and interferon-gamma (IFN-gamma) immune responses against opportunistic pathogens, HCV, and HIV-1 p24 were evaluated.
Median HCV VLs, CD4 counts, T-cell subsets, and IFN-gamma-producing T-cell frequencies against opportunistic pathogens and HIV-1 p24 did not change over time. HCV-specific T cells were observed ex vivo in two patients pretransplantation and in two others post-transplantation. HCV-specific in vitro amplification enabled the detection of HCV-specific IFN-gamma-producing responses in three further patients post-transplantation. Anti-HCV responses were observed independently of anti-HCV therapy and were undetectable in patients with severe hepatitis or liver fibrosis.
These results demonstrate that LT in HIV-HCV coinfected patients is not deleterious to the immune system and does not alter immune responses directed against HCV, HIV, or opportunistic pathogens.
背景/目的：肝移植（LT）在免疫抑制的人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）合并感染患者中是可行的，但对于肝移植物中 HCV 复发的严重程度和免疫功能的保存存在疑问。我们研究了 LT 是否对免疫系统有害。
14 例 HIV-HCV 合并感染患者（HIV 病毒载量[VL] <50 拷贝/ml；移植前中位 CD4 计数为 276/mm³）因 HCV 肝硬化接受移植，并随访 2 年以上。9 例患者在移植后接受抗 HCV 治疗。监测 HCV 和 HIV VLs 以及急性和慢性肝炎的程度。评估外周血 T 细胞表型和针对机会性病原体、HCV 和 HIV-1 p24 的干扰素-γ（IFN-γ）免疫反应。
HCV VLs、CD4 计数、T 细胞亚群和针对机会性病原体和 HIV-1 p24 的 IFN-γ 产生 T 细胞的频率中位数在整个研究期间没有变化。两名患者在移植前，另外两名患者在移植后可观察到 HCV 特异性 T 细胞。HCV 特异性体外扩增可在另外三名移植后患者中检测到 HCV 特异性 IFN-γ 产生反应。抗 HCV 反应独立于抗 HCV 治疗而发生，在严重肝炎或肝纤维化患者中无法检测到。
这些结果表明，HIV-HCV 合并感染患者的 LT 对免疫系统无害，并且不会改变针对 HCV、HIV 或机会性病原体的免疫反应。
