HIV No Barrier to Getting Liver Transplant, Study Finds

Procedure recommended to treat aggressive liver cancer

By Mary Elizabeth Dallas

HealthDay Reporter

FRIDAY, May 17 (HealthDay News) -- Liver transplants to treat a common type of liver cancer are a viable option for people infected with HIV, according to new research.

The Italian study, published May 10 in the journal The Oncologist, found that the AIDS-causing virus doesn't affect survival rates and cancer recurrence after transplants among HIV patients with this particular type of liver cancer, called hepatocellular carcinoma (HCC). The study's authors noted, however, that HCC is more aggressive in people with HIV and it is becoming a major cause of death among these patients as antiretroviral treatment prolongs their lives.

"The key message of this study is that liver transplantation is a valid option for HCC treatment in HIV-infected patients," the study's authors wrote in a journal news release. "We suggest that HIV-infected patients must be offered the same liver transplant options for HCC treatment currently provided to HIV-uninfected subjects."

The study involved 30 HIV-positive patients and 125 patients not infected with HIV who received a liver transplant to treat HCC at three different hospitals in northern Italy between 2004 and 2009.

During a follow-up period of roughly 32 months, the researchers found a recurrence of HCC in 6.7 percent of the patients with HIV and 14.4 percent of the patients who were not HIV positive.

The study also revealed that survival was similar for all of the patients one year after surgery and three years post-surgery.

The researchers, led by Dr. Fabrizio Di Benedetto, associate professor of surgery at the University of Modena, said the HIV-positive patients were treated with antiretroviral therapy until they underwent the transplant. The therapy was not resumed until their liver function stabilized after surgery.

None of the HIV-positive patients developed AIDS during the post-surgery follow-up period. The study's authors suggested that this may be due to timely resumption of HIV therapy following the liver transplant.

New options in antiviral therapy for people with HIV could improve control of the HIV virus as well as outcomes following liver transplant for HCC, the researchers said.

Patients with HIV undergoing liver transplant for HCC would benefit most from a multidisciplinary approach to care, the study authors said, which would involve collaboration among oncologists, radiologists, gastroenterologists, liver surgeons and infectious disease specialists.

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Fecal Transplant Studied for Kids With Bowel Disease

WEDNESDAY, April 17 (HealthDay News) -- Fecal transplantation -- an innovative enema treatment -- may help reduce or eliminate symptoms of ulcerative colitis in most children and young adults, according to a small study.

The process, formally called fecal microbial transplantation, involves placing stool from a healthy donor into a recipient's intestines in order to restore healthy bacteria.

The early clinical trial -- the first in the United States to study the process in children -- was conducted by a team at Helen DeVos Children's Hospital in Grand Rapids, Mich.

The study included 10 participants, aged 7 to 20 years, with mild to moderate ulcerative colitis. Enemas were used to give the patients lab-prepared stool samples from a healthy adult donor. Each patient received five such treatments within one week.

Seventy-eight percent of the patients had a reduction in ulcerative colitis symptoms within a week, and 67 percent still had reduced symptoms a month after fecal transplantation. Thirty-three percent of the patients no longer had any symptoms of ulcerative colitis after the process.

No serious side effects were noted, according to the study, which was published online and in the June print issue of the Journal of Pediatric Gastroenterology & Nutrition.

Ulcerative colitis is a type of inflammatory bowel disease that affects the lining of the large intestine, or colon, and rectum, according to the U.S. National Institutes of Health. Symptoms can include abdominal pain, cramping, bloody diarrhea, pus in the stool, fever, rectal pain, weight loss, nausea, vomiting, joint pain, mouth sores, skin lesions and slow growth in children.

The disease often forces children to miss school and limit their social activities.

Fecal transplantation "has been proposed as a promising new treatment option for recurrent C. difficile infection and possibly for ulcerative colitis," lead investigator and pediatric gastroenterologist Dr. Sachin Kunde said in a hospital news release.

"We believe that the procedure may restore 'abnormal' bacteria to 'normal' in patients with ulcerative colitis," Kunde said. "Our short-term study looked at the safety and tolerability of [fecal microbial transplantation] for these patients."

Larger and longer studies are needed before the process could be recommended for clinical practice, the researchers said.

As many as 700,000 Americans have ulcerative colitis, and approximately 25 percent are diagnosed during childhood, according to the Crohn's and Colitis Foundation. Kunde said fecal transplantation could offer patients a natural, inexpensive treatment option.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Helen DeVos Children's Hospital, news release, April 2013

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HIV No Barrier to Getting Liver Transplant, Study Finds

Procedure recommended to treat aggressive liver cancer

By Mary Elizabeth Dallas

HealthDay Reporter

FRIDAY, May 17 (HealthDay News) -- Liver transplants to treat a common type of liver cancer are a viable option for people infected with HIV, according to new research.

The Italian study, published May 10 in the journal The Oncologist, found that the AIDS-causing virus doesn't affect survival rates and cancer recurrence after transplants among HIV patients with this particular type of liver cancer, called hepatocellular carcinoma (HCC). The study's authors noted, however, that HCC is more aggressive in people with HIV and it is becoming a major cause of death among these patients as antiretroviral treatment prolongs their lives.

"The key message of this study is that liver transplantation is a valid option for HCC treatment in HIV-infected patients," the study's authors wrote in a journal news release. "We suggest that HIV-infected patients must be offered the same liver transplant options for HCC treatment currently provided to HIV-uninfected subjects."

The study involved 30 HIV-positive patients and 125 patients not infected with HIV who received a liver transplant to treat HCC at three different hospitals in northern Italy between 2004 and 2009.

During a follow-up period of roughly 32 months, the researchers found a recurrence of HCC in 6.7 percent of the patients with HIV and 14.4 percent of the patients who were not HIV positive.

The study also revealed that survival was similar for all of the patients one year after surgery and three years post-surgery.

The researchers, led by Dr. Fabrizio Di Benedetto, associate professor of surgery at the University of Modena, said the HIV-positive patients were treated with antiretroviral therapy until they underwent the transplant. The therapy was not resumed until their liver function stabilized after surgery.

None of the HIV-positive patients developed AIDS during the post-surgery follow-up period. The study's authors suggested that this may be due to timely resumption of HIV therapy following the liver transplant.

New options in antiviral therapy for people with HIV could improve control of the HIV virus as well as outcomes following liver transplant for HCC, the researchers said.

Patients with HIV undergoing liver transplant for HCC would benefit most from a multidisciplinary approach to care, the study authors said, which would involve collaboration among oncologists, radiologists, gastroenterologists, liver surgeons and infectious disease specialists.

View the original article here