237 Cutaneous infection rates are not affected by chronic HIV(+) or HCV(+) coinfection in organ transplant recipients

Purpose: HIV and Hepatitis C (HCV) are two immune dysregulatory processes that may exacerbate the risk of infection in organ transplant recipients (OTR), a cohort that exhibits significantly increased risk at baseline due to iatrogenic immunosuppression. Our aim is to elucidate whether OTR with HIV or HCV constitute a unique cohort that demands specialized risk stratification and dermatologic management. Methods: Retrospective chart review evaluated 427 OTR over a 5-year period between 11/1/11 and 11/1/16. Results: Seventy OTR were diagnosed with either HCV or HIV. The mean age of the cohort was 61 years and time of immunosuppression was 7 years. Two patients were coinfected with both viruses. The incidences of fungal infection were 28.6% (N=20) and 18.7% (N=64) for the HCV/HIV OTR and non-coinfected OTR groups, respectively. The incidences of viral infection were 8.6% (N=6) and 14.3% (N=49). Independent proportion tests did not reveal significant differences between the infected patients vs. non-infected patients in viral, fungal, or bacterial infection rates. Although statistical analysis did not indicate a significant relationship between HCV/HIV status and incidence of fungal infection (p = 0.06), the HCV status of a patient was determined to have a marked effect on the likelihood of fungal infection (Z = -1.87, d = 3.57, 95% CI [3.47-3.68]). Conclusions: While our data show the OTR population to be at risk for skin infections while receiving long-term immunosuppression, coinfection with HIV or HCV was not found to significantly increase the risk of bacterial, fungal, or viral infection. However, given the sizable effect found when analyzing fungal infection rates in our cohort, we suspect that further investigations with larger sample sizes may demonstrate significant relationships.