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Improved Survival after Liver Transplantation for Patients with HIV and HIV/HCV Coinfection in the INSTI and DAA eras.

BACKGROUND
Patients with human immunodeficiency virus (HIV) with and without hepatitis C virus (HCV) coinfection had poor outcomes after liver transplant (LT). Integrase strand transfer inhibitors (INSTI) and direct-acting antivirals (DAA) changed the treatment landscape for HIV and HCV, respectively; their impact on LT outcomes remains unclear.


METHODS
This retrospective analysis of adults with HIV monoinfection (n = 246) and HIV/HCV coinfection (n = 286) who received LT compared mortality in patients with HIV who received LT before vs. after approval of INSTI and in patients with HIV/HCV coinfection who received LT before vs after approval of DAA. In secondary analysis, we compared the outcomes in the different eras with those of propensity score (PS) matched control cohorts of LT recipients without HIV or HCV infection.


RESULTS
HIV monoinfected LT recipients did not experience a significant improvement in survival between the pre-INSTI and INSTI recipients with HIV (aHR 0.70 [0.36-1.34). However, recipients with HIV/HCV coinfection in the DAA era had a 47% reduction (aHR 0.53 [0.31-9.2] in one-year mortality than co-infected recipients in the pre-DAA era. Compared to non-HIV or HCV recipients, HIV monoinfected recipients had higher mortality during the pre-INSTI era (aHR, ), but survival was comparable between groups during the INSTI era (aHR, ). HIV/HCV coinfected recipients also experienced comparable survival during the DAA era compared to non-HIV or HCV recipients (aHR, ).


CONCLUSIONS
Post-LT survival for patients with HIV monoinfection and HIV/HCV coinfection has improved with the introduction of INSTI and DAA therapy, suggesting that LT has become safer in these populations.