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Guide to Hepatitis B for People Living With HIV

June 2009

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Section 9: Managing Cirrhosis

A damaged liver can still function, but people who have developed cirrhosis are at risk for liver failure and other serious, life-threatening complications. People with compensated cirrhosis should be screened for liver cancer and monitored regularly for decreasing liver function and varices (stretched and bursting veins in the esophagus or stomach). Beta blockers can help prevent varices. Variceal hemorrhaging is managed with medication and endoscopic intervention (banding and injection). In some patients, a procedure called TIPSS (Transjugular Intrahepatic Portasystemic Stent Shunt), insertion of a metal mesh tube (stent) through the liver to relieve blood pressure by connecting two large veins, may be recommended.

Changing your diet may help to manage some of the complications of cirrhosis. Cutting down on salt and eating many small light meals per day, with protein from vegetables and dairy products rather than meat, can help redress nutritional imbalances. A nutritionist and your doctor can help you plan a healthy diet.

When liver function has deteriorated and hepatic decompensation occurs, a liver transplant becomes necessary.

Liver Transplant in People with HIV/HBV Coinfection

In people with severe decompensated liver disease, a liver transplant is the final option.

This is a major operation, and success rates vary. It is also complicated by a scarcity of donor organs that are available for transplant.

For many years, transplant services actively avoided transplanting organs into HIV-positive people. This was due to several factors: discrimination from some surgeons who did not want to operate on HIV-positive people; the poor long-term prognosis for HIV-positive people before effective HIV treatment was available, which meant that a donor organ would provide fewer years of additional life than it might to a person without HIV or other medical conditions; and concerns about using immunosuppressive drugs in HIV-positive people.

The effectiveness of HIV drugs has changed this. HIV is no longer an exclusion criterion for transplantation in some places. Centers in the U.S., Spain, France, and the U.K. have transplanted livers into HIV-positive candidates; results have been mixed. Some centers have reported no significant difference in survival according to HIV status, but medical management remains complex due to drug interactions between immunosuppressants and protease inhibitors; graft rejection; reactivation of HBV; and difficulty in tolerating HIV- and HBV treatment after transplantation.

 

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This article was provided by Treatment Action Group.
 
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