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Liver transplant for advanced Hep C with HIV
Apr 14, 2013

My husband has been HIV and Hep C positive since 1988. His t cell count for the last several years has been in the 400 range with an undetectable viral load. He has Hep C genotype 2 and has done Pegasys/Ribavirin and Pegintron/Ribavirin with no success the first time, success the second time but had to stop for a low platelet count after 4 weeks. His liver now, we are told, cannot handle the treatment any longer but we were also told he is NOT a candidate for liver transplant because he is 50, his HIV is NOT well controlled when his viral load has been undetectable for years and his tcells are in the 400's. They also said he is not a candidate because he is still hep c positive and if they give him a liver his body will kill it. Is this true or is this one experts opinion. I've read that people with HIV are now being accepted as organ donors to others with HIV. He has no other options but is still otherwise doing well. He looks fine, has no ascetites but his platelet count is still low. We were told his liver is still doing its job, it is just a question of how long this will continue. He does not drink alcohol and has not drank in years. I just want to be sure he has no other options. The last liver specialist we saw thought he was a candidate for liver transplant and this one we saw today said absolutely not. Thank you for your time and attention to this question.

Response from Dr. Taylor

I am sorry your are receiving conflicting information. This can be very hard and confusing. It sounds as though your husband has cirrhosis, and well-controlled HIV on HIV medications. Ways to help the liver include not using alcohol, not smoking, maintaining a healthy weight, and keeping the HIV viral load undetectable with HIV medications.

For HIV-infected people with cirrhosis of the liver, it is helpful to be screened for liver cancer every 6 months, with an ultrasound of the belly. Some experts also suggest getting a blood test called AFP. Being screened for varices (swollen blood vessels inside the body) is also important.

I would check with your doctors about sofosbuvir, a new hep C drug under consideration by the US FDA. It can be given with ribavirin, without interferon, for genotype 2 infections. It appears to be very effective. Perhaps your doctors can see if they can get it before FDA approval, sometimes call 'compassionate release.'

Liver transplant is not a panacea and can be complicated for people with both HIV and HCV. The new liver can get infected and very sick with hep C right after the transplant. Many HIV-infected people do poorly then after transplant. However it would be good to clarify why exactly your husband is not considered a candidate, as I am not hearing any clear reasons. I would discuss with your doctors the pros and cons of transplant versus not transplanting, and about treating with interferon-free medications as they become available. I wish you both the very best.

Lab question
hep B Detected or not?

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