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Canadian Journal of Gastroenterology
Volume 21 (2007), Issue 3, Pages 179-182
http://dx.doi.org/10.1155/2007/769752
Original Article

Barriers Preventing Liver Transplantation in Canadians with HIV Infection – Perceptions of HIV Specialists

Curtis L Cooper,1 Joanne DeForest,2 John Gill,2 Richard Lalonde,3 and on behalf of the Canadian HIV Trials Network (CTN) Co-Infection Core Group1

1University of Ottawa, Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
2University of Calgary, Calgary, Alberta, Canada
3McGill University, Montreal, Quebec, Canada

Received 5 May 2006; Accepted 21 September 2006

Copyright © 2007 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Liver transplantation is a life-saving procedure with demonstrated utility. There are accumulating data indicating that this procedure is helpful in HIV-infected patients as well. Liver transplantation is currently largely unavailable to those living with HIV in Canada. Understanding the obstacles to this procedure is the first step to increasing access. Between August 2005 and November 2005, HIV physicians, one from each Canadian HIV Trials Network site, were asked to complete a quantitative questionnaire on adult liver transplant access and need. Forty-six per cent (16 of 35) of sites responded. A median 20% of the nearly 12,700 HIV patients followed at these sites had concurrent liver disease (20% caused by hepatitis C virus, 5% caused by hepatitis B virus and 5% were alcohol-related). On average, two patients per site were thought to be appropriate candidates for liver transplant evaluation. Eighty per cent of respondents anticipated increased need for liver transplantation over the next five years. Organ supply was universally identified as the chief obstacle to transplantation in patients with HIV. Other key issues included risk of hepatitis C virus reinfection and transplant surgical team willingness. Based on these data, it is believed that these issues should be the focus of efforts designed to increase access to transplantation in Canadians with end-stage liver disease and concurrent HIV.