ACUTE LIVER FAILURE IN HIV INFECTED PATIENTS: A SINGLE CENTER EXPERIENCE

Background: Management and results of liver transplantation (LT) in HIV + patients with acute liver failure (ALF) and fulminant hepatitis (FH) are poorly known.Aim: To describe the evolution of ALF in HIV + patients and the results of LT in this indication.Patients and Methods: Between June 2002 and January 2012, 15 HIV + patients (9 male, mean age 40 years [25-53]) were admitted to our centre for ALF (PT/FV <50%).Eleven patients were treated by HAART (3 of them by ddI/d4T) and 5 had medical history of opportunistic disease.Results: On admission, the average level of total bilirubin, ALT, creatinine, INR and CD4 count were respectively: 233 mmol/L [50-620], 2472 IU/L [208-7929], 222 mmol/L [34-773], 5 [1.4-15], 345 giga/L [50-1200].HIV viral load was <20 cp/ml in 8 patients.Four patients were HBV+, 1 patient HCV+ and 2 patients had an alcohol abuse (>40gr/day).Pathological examination (METAVIR) showed no fibrosis (F0) in 11 patients and chronic liver disease (F2) in 4. HAS' cause was: drug-induced hepatitis (nevirapine= 2, acetaminophen= 2, abacavir/ritonavir= 1, isoniazid/rifampicin= 1), IRIS (n = 3), DRESS syndrome (n = 1), herpetic hepatitis (n = 1), HBV reactivation (n = 1), unknown for 3. 7 patients experienced spontaneous recovery and 1 patient died of ventricular haemorrhage.7 patients, 2 with positive HIV PCR (2.1 and 2.9 log, respectively) were listed for emergency LT due to FH with a mean waiting time of 1 day [0-2]: 2 patients died before LT due to cerebral oedema and 5 patients were transplanted.One patient died 40 days after LT because of severe sepsis, one patient had hemi-colectomy for ischemic colitis and one patient experience seizures.Post transplantation evolution of 4 pts was characterized by: median survival of 24 months (3-64), no opportunistic infection, last mean CD4 count of 530 giga/L [270-731] and HIV viral load <20 cp/ml on HAART.Conclusions: In case of acute liver failure, the prognosis of HIV+ patients is severe with 50% evolving to fulminant hepatitis.Preliminary results of liver transplantation for fulminant hepatitis in HIV+ patients are encouraging with 80% survival at 24 months.