Liver transplantation in HIV-HCV coinfected candidates: What is the most appropriate time for evaluation?

Liver disease due to hepatitis C virus (HCV) represents an increasing cause of end-stage liver disease (ESLD) among HIV-infected individuals. Orthotopic liver transplantation (OLT) is currently the only hope for these patients. We analyzed the outcome of candidates who underwent OLT at our clinic between January 2003 and January 2004. Out of 366 HIV-HCV-coinfected individuals assessed, 16 (4%) were considered appropriate candidates for OLT. However, none of them has been transplanted so far. Death due to ESLD occurred in 4 (25%) of them within 3-8 months after evaluation was initiated. In conclusion, the mortality of HIV-HCV-coinfected patients with ESLD waiting for OLT is high. An earlier assessment of HCV-HIV-coinfected candidates as well as improved strategies to make OLT available sooner after the assignment of patients to this procedure should be warranted.