Improving the Management of HIV Disease Vol. 6, no. 5 [World Conference on AIDS (12th: 1998: Geneva)]

QUESTIONS TO THE ANTIRETROVIRAL THERAPY AND RESISTANCE TESTING PANELS
Vil. EPTIIS O9 ECIO

lization of liver transplants in HIV-infected patients are very complicated. I
believe that the advisability of this as a
process merits the consensus deliberations of a number of experts. The risk
and expense of such a procedure with
the very limited availability of organs
requires much thoughtful input.
DR VOLBERDING: The most common
cause of liver damage necessitating transplantation in the United States is hepatitis C virus infection. This infection is
extremely common in patients with HIV
infection. Most transplant centers reject
those with HIV coinfection given the presumably real risk of acceleration of HIV

disease associated with transplant-related
immune suppression. Some centers are
beginning to consider such procedures,
which I believe can be appropriate given
our current ability to control HIV replication. In many patients, death will result
from hepatic failure well before HIV disease progresses to advanced stages.
Certainly, the potential risks of this need
to be considered, but I do not favor an
outright prohibition.

DR RICH MAN: Chronic hepatitis B and
C infections are increasingly confounding
HIV patient management, especially with
regard to the use of protease inhibitors.
Issues of risk-benefit and health care uti
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VOLUME 6, OCTOBER 1998