48 Further prospective study is needed to delineate the clinical factors that accompany the steep decline. Data are now accumulating in the United States and Europe regarding outcomes of liver transplantation in HIV-infected patients. Of the transplants that have been performed, roughly half have been performed for HCV-associated ESLD, the other half for HBV-related ESLD. Uniformly, HIV-specific outcomes have
been excellent, with virtually complete control of HIV viremia with HAART, and no progression to AIDS observed among persons who have been able to continue HAART postoperatively. With the use of immunoprophylaxis with hepatitis B immune globulin RO4929097 and antiviral prophylaxis with lamivudine or adefovir, the success rates of HBV-related ESLD have been excellent and on par with HIV-negative outcomes. In contrast, the 3-year survival rates for those undergoing orthotopic liver transplantation for HCV ESLD have been lower in both the United States and Europe, and compare somewhat unfavorably with HIV-negative outcomes. The major reason for the decrement in graft and patient survival has been aggressive recurrent HCV. Curiously, in a small but striking number of patients, spontaneous
clearance of HCV has been observed. The factors that underlie this spontaneous conversion have not been elucidated. Clearly, much work is required 上海皓元医药股份有限公司 to understand the host, graft, and viral factors that underlie the widely divergent outcomes of HIV-positive persons Angiogenesis inhibitor undergoing liver transplant for HCV ESLD. The management of liver disease in the setting of HIV must take into account social, psychiatric, and cultural issues that impact disease transmission, prevention, diagnosis, and treatment. While most people are risk-averse, a high proportion of patients with HIV infection are “risk takers”, and their behavior is manifest by actions that provide immediate gratification with little concern
for consequences. These behaviors lead to increased risk of HIV, HCV, and HBV as well as comorbid drug and alcohol toxicities. Animal studies have clearly demonstrated the powerful addictive potential of agents such as cocaine, and this group of patients is highly susceptible to drug experimentation and subsequent addiction. Behavioral modification techniques seem to be critical in the management of such patients, both in terms of addiction management and in the ability to successfully maintain and/or complete antiretroviral or time-limited HCV therapy. The most effective therapeutic manipulations involve development of a reward/punishment system that utilizes the existing behavioral patterns to achieve a desirable outcome. There is significant ongoing interest in the generation of new research activity in the area of HIV and liver disease.