Improvements in Liver Transplantation Outcomes in Patients with Hepatitis C Virus/HIV Coinfection after the Introduction of Direct-Acting Antiviral Therapies

Introduction: Although liver transplantation (LT) outcomes in patients with hepatitis C virus (HCV) infection have improved after the introduction of direct-acting antivirals (DAAs), their impact on patients with HCV/HIV coinfection has not been evaluated. We aimed to assess the effects of DAAs on post-LT outcomes in patients with HCV/HIV compared with those with HIV or HCV mono-infection. Methods: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing data, we compared post-LT graft survival in patients with HCV and/or HIV before and after DAAs introduction. Patients were classified into the following eras: era 1 (2008-2012 [pre-DAAs]) and era 2 (2014-2019 [post-DAAs]). Patients who received transplants in 2013 were excluded to allow a washout period of the effect of DAAs. Inverse probability weighting was used to adjust characteristic differences between eras. Analyses considered possible infection by era interactions. Results: A total of 18,053 LT recipients were identified (HCV/HIV [n = 160]; HCV mono-infection [n = 17,705]; HIV mono-infection [n = 188]). In era 1, the 1-year graft survival rate in the coinfection group was significantly worse than in HCV and HIV mono-infection groups, but no difference was detected in era 2 (Fig. 1). Both HCV/HIV and HCV mono-infection had significant reduction on year-1 graft loss, compared with era 1; hazard ratio 0.25 (95% CI, 0.14 to 0.43) for HIV/HCV and hazard ratio 0.61 (95% CI, 0.57 to 0.65) for HCV (Table 1). Improvement was more prominent in the coinfection group. There was no significant change in patients with HIV mono-infection. Conclusion: After the introduction of DAAs, more significant improvements in post-LT outcomes were observed in patients with coinfection compared with those with HIV or HCV mono-infection