Gutiérrez-Moreno M, Bernal-Bellido C, Suárez-Artacho G, Alamo-Martínez J M, Marín-Gómez L M, Serrano-Díaz-Canedo J, Padillo-Ruiz F J, Gómez-Bravo M A
Department of General and Digestive System Surgery, Virgen del Rocio University Hospital, Seville, Spain.
Transplant Proc. 2012 Sep;44(7):2100-2. doi: 10.1016/j.transproceed.2012.07.074.
Hepatitis C virus (HCV) clearance is an independent predictive factor for long-term survival in HIV-HCV liver transplantation patients. After 46 months of antiviral therapy it is achieved in up to 80% of cases. Little is known, however, about spontaneous viral clearance. We performed prospective study of HIV-HCV coinfected liver transplant patients.
Between January 1, 2001, and December 31, 2011, we analyzed the parameters from among HIV-HCV coinfected liver transplant patients of donor and recipient ages, transplant cause, Model for End-Stage Liver Disease (MELD) score, donor and recipient serology, transplant date, viral load before and after transplantation, immunosuppressive therapy, HCV recurrence, HCV viral clearance (spontaneous and duration), retransplant cause, and viral load before and after retransplant, as well as survival.
The seven transplanted HIV-HCV coinfected patients had most commonly HCV-related hepatocarcinoma (n = 5, 71.42%). Three subjects (42.85%) developed HCV recurrences. Two patients (28.57%) were retransplanted, both due to HCV recurrence with one of them developing a spontaneous clearance of HCV (14.28%). This patient showed a preoperative HIV viral load < 50 copies IU/mL, CD4+ count 486/μL, HCV-RNA 2564 IU copies/mL, Anti-HBc+, and MELD 30. The donor was an 81-year-old female who was Anti-HBc+. Immunosuppressive therapy consisted of cyclosporine, mycophenolate, and prednisone. One month after transplantation, the patient developed an acute cellular rejection episode with progression of liver disease secondary to the HCV recurrence (56.5 × 105 copies IU/mL). He started antiviral treatment (α-interferon and ribavirin), but due to side effects and interactions with the antiretrovirals, they were stopped after four doses. The viral load decreased spontaneously and progressively until it became negative at 146 days after transplantation; he was retransplanted and HCV-RNA has continued to be negative after 772 days.
Spontaneous clearance of HCV among HIV-HCV coinfected liver transplant patients is possible. Despite no treatment, one patient still has no detectable HCV viral load after retransplantation.
丙型肝炎病毒（HCV）清除是HIV-HCV肝移植患者长期生存的独立预测因素。经过46个月的抗病毒治疗，高达80%的病例可实现病毒清除。然而，关于自发病毒清除的情况却知之甚少。我们对HIV-HCV合并感染的肝移植患者进行了前瞻性研究。
在2001年1月1日至2011年12月31日期间，我们分析了HIV-HCV合并感染的肝移植患者的参数，包括供体和受体年龄、移植原因、终末期肝病模型（MELD）评分、供体和受体血清学、移植日期、移植前后的病毒载量、免疫抑制治疗、HCV复发、HCV病毒清除（自发清除及持续时间）、再次移植原因以及再次移植前后的病毒载量，还有生存情况。
7例接受移植的HIV-HCV合并感染患者最常见的病因是HCV相关肝癌（n = 5，71.42%）。3例患者（42.85%）出现了HCV复发。2例患者（28.57%）接受了再次移植，均因HCV复发，其中1例出现了HCV自发清除（14.28%）。该患者术前HIV病毒载量<50拷贝/国际单位/mL，CD4+细胞计数486/μL，HCV-RNA 2564国际单位/拷贝/mL，抗-HBc阳性，MELD评分为30。供体是一名81岁的抗-HBc阳性女性。免疫抑制治疗包括环孢素、霉酚酸酯和泼尼松。移植后1个月，患者发生急性细胞排斥反应，继发于HCV复发的肝病进展（56.5×105拷贝/国际单位/mL）。他开始抗病毒治疗（α干扰素和利巴韦林），但由于副作用以及与抗逆转录病毒药物的相互作用，在4剂后停药。病毒载量自发且逐渐下降，直至移植后146天变为阴性；他接受了再次移植，772天后HCV-RNA仍为阴性。
HIV-HCV合并感染的肝移植患者中HCV自发清除是可能的。尽管未进行治疗，但1例患者再次移植后仍未检测到HCV病毒载量。
