Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Am J Transplant. 2012 Jul;12(7):1866-76. doi: 10.1111/j.1600-6143.2012.04028.x. Epub 2012 Apr 4.
Eighty-four HCV/HIV-coinfected and 252-matched HCV-monoinfected liver transplant recipients were included in a prospective multicenter study. Thirty-six (43%) HCV/HIV-coinfected and 75 (30%) HCV-monoinfected patients died, with a survival rate at 5 years of 54% (95% CI, 42-64) and 71% (95% CI, 66 to 77; p = 0.008), respectively. When both groups were considered together, HIV infection was an independent predictor of mortality (HR, 2.202; 95% CI, 1.420-3.413 [p < 0.001]). Multivariate analysis of only the HCV/HIV-coinfected recipients, revealed HCV genotype 1 (HR, 2.98; 95% CI, 1.32-6.76), donor risk index (HR, 9.48; 95% CI, 2.75-32.73) and negative plasma HCV RNA (HR, 0.14; 95% CI, 0.03-0.62) to be associated with mortality. When this analysis was restricted to pretransplant variables, we identified three independent factors (HCV genotype 1, pretransplant MELD score and centers with <1 liver transplantation/year in HIV-infected patients) that allowed us to identify a subset of 60 (71%) patients with a similar 5-year prognosis (69%[95% CI, 54-80]) to that of HCV-monoinfected recipients. In conclusion, 5-year survival in HCV/HIV-coinfected liver recipients was lower than in HCV-monoinfected recipients, although an important subset with a favorable prognosis was identified in the former.
84 例 HCV/HIV 合并感染和 252 例 HCV 单感染肝移植受者纳入一项前瞻性多中心研究。36 例（43%）HCV/HIV 合并感染和 75 例（30%）HCV 单感染患者死亡，5 年生存率分别为 54%（95%CI，42-64）和 71%（95%CI，66-77；p=0.008）。当同时考虑两组时，HIV 感染是死亡的独立预测因素（HR，2.202；95%CI，1.420-3.413 [p<0.001]）。仅对 HCV/HIV 合并感染受者进行多变量分析，发现 HCV 基因型 1（HR，2.98；95%CI，1.32-6.76）、供体风险指数（HR，9.48；95%CI，2.75-32.73）和阴性血浆 HCV RNA（HR，0.14；95%CI，0.03-0.62）与死亡率相关。当将该分析仅限于移植前变量时，我们确定了三个独立因素（HCV 基因型 1、移植前 MELD 评分和感染 HIV 患者中每年肝脏移植量<1 的中心），这些因素使我们能够确定一组 60 例（71%）患者具有与 HCV 单感染受者相似的 5 年预后（69%[95%CI，54-80]）。总之，HCV/HIV 合并感染肝移植受者的 5 年生存率低于 HCV 单感染受者，但在前者中确定了一个预后良好的重要亚组。
