Don't deny liver transplantation to HIV patients with hepatocellular carcinoma in the highly active antiretroviral therapy era.

In an era of highly active antiretroviral therapy(HAART), liver transplantation is becoming an effective therapy inHIV patients suffering from hepatitis C virus (HCV)/hepatitis B virus(HBV) cirrhosis.1 The increase in survival of patients with HIV infection,attributed to HAART, has prompted the medical community toconsider therapeutic strategies including the possibility of major surgeryand solid organ transplantation to contrast the clinical picture ofend organ failure.In this clinical setting, several studies have consistently associatedan increased risk of death as a result of hepatocellular carcinoma(HCC) with HIV infection.2 In a large French survey, HCC-relateddeath in HIV patients rose from 11% in 1997 to 25% in 2001.3 Moreover,some reports have emphasized a more aggressive course ofHCCwith respect to HCC seen in HIV-negative individuals.4,5 In particular,the HCC is diagnosed at a younger age, and is generally more advanced(infiltrating ormetastatic) at diagnosis.6 Recent evidences suggesta crucial role of the HIV TAT protein to drive hepatocarcinogenesis inpatients with virus- or alcohol-mediated cirrhosis7,8; a coexistent weakerantitumor response because of a chronically low CD4 and CD8 lymphocytecounts must also be kept in due consideration. Consequently, amorefrequentscreeningthanevery6monthshasbeenwarrantedbecauseof the swifter course of HCC