HIV-infected patients and liver transplantation: who, when and why.

Well into the 25th year of the HIV pandemics, and into the 15th year of the highly active antiretroviral therapy (HAART) era, liver transplantation (LT) in the HIV population might be viewed as both a problem and an opportunity. It is still a problem when we consider that only a small proportion of all HIV-infected patients with end stage liver disease (ESLD) will have access to this precious and limited resource. But, in the face of the continuous HAART refinements, that will probably expand in the future the pool of potential HIV- organ recipients, LT is also an opportunity. Considering the poor results observed in a subset of HIV/HCV coinfected patients with an ESLD in comparison to HCV monoinfected ones, LT is still a problem. But it is an opportunity if large and well designed clinical trials will reveal favourable prognostic factors associated to the subset of HIV/HCV coinfected patients that may undergo LT with satisfactory results. Available data presently support with good evidence the practice of LT in HIV population. Thus, the issue is no longer "whether it is correct to transplant HIV-infected patients", but "who are the patients that can be safely transplanted" and "when is the most correct timing to perform the surgical procedure". Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survival, are strictly related to patient selection and correct timing for transplantation. Aim of this article is to review some of the issues concerning HIV infection and LT, particularly with regard the opportunity of LT option in HIV setting and the most appropriate evaluation of an HIV-infected candidate for LT.