Información del artículo
Actualmente se estima que en España hay entre 60.000 y 80.000 personas coinfectadas por el virus de la inmunodeficiencia humana (VIH) y el virus de la hepatitis C (VHC) y de 5.000 a 10.000 personas infectadas por VIH y virus de la hepatitis B (VHB), de los cuales el 10-15% está afectado de una cirrosis hepática. Por ello la enfermedad hepática terminal es una de las primeras causas de muerte en nuestro país. El trasplante hepático es la única alternativa terapéutica en estos casos. La experiencia acumulada en América del Norte y Europa en los últimos 5 años indica que la supervivencia a los 3 años del trasplante hepático es similar a la de los pacientes VIH negativos. Los criterios utilizados para seleccionar a los pacientes VIH han sido: no haber tenido infecciones oportunistas, tener una cifra de linfocitos CD4 > 100 cél./mm3 y una carga viral del VIH suprimible con tratamiento antirretroviral. En España, donde la mayoría de pacientes eran antiguos drogadictos, se exigía además una abstinencia a la heroína y cocaína de 2 años de duración, y el paciente podía estar en el programa de metadona. En España se han realizado 26 trasplantes hepáticos en otros tantos pacientes, de los cuales sólo dos han fallecido (7%) tras una mediana de seguimiento de 8 meses (límites, 1-28). Los principales problemas en el período postrasplante en todas las series han sido la recidiva de la infección por el VHC, que es la principal causa de mortalidad postrasplante, y las interacciones farmacocinéticas y farmacodinámicas entre los antirretrovirales y los inmunosupresores. La experiencia del tratamiento con interferón pegilado y ribavirina es escasa en esta población.
Palabras clave:
Trasplante hepático
VHC
VHB
VIH
España
According to current estimates, there are 60,000 to 80,000 HIV and HCV coinfected individuals in Spain, and 5,000 to 10,000 HIV and HBV coinfected individuals. Among these patients, 10% to 15% have liver cirrhosis. Thus, end-stage liver disease is one of the major causes of death in our country. Liver transplantation is the only therapeutic option for these patients. Accumulated experience in North America and Europe in the last five years indicates that three-year survival in HIV-positive liver transplant recipients is similar to that of HIV-negative recipients. The selection criteria for HIV transplant candidates includes the following: no history of opportunistic infections, CD4 lymphocyte count higher than 100 cells/mm3, and HIV viral load suppressible with antiretroviral treatment. In Spain, where the majority of patients are former drug abusers, complete abstinence from heroin or cocaine use during two years is also required, with the possibility of the patient being in a methadone program. To date 26 hepatic transplants have been performed in the same number of patients, with only two deaths (7%) after a median follow-up of eight months (1-28). The main problems in the post-transplantation period in all the series has been recurrent HCV infection, which is the principle cause of post-transplantation mortality, and pharmacokinetic and pharmacodynamic interactions between the antiretroviral and immunosuppressive agents. There is little experience with pegylated interferon and ribavirin treatment in this population.
Key words:
Hepatic transplant
HCV
HBV
HIV
Spain
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