Infection with HIV may lead to the development of cardiomyopathy as improved antiretroviral regimens continue to prolong patient life. However, advanced therapeutic options, such as heart transplant, have until recently been precluded to HIV-positive persons. A favorable long-term outcome has been obtained after kidney or liver transplant in HIV-positive recipients fulfilling strict virological and clinical criteria. We recently reported the first heart transplant in a HIV-infected patient carried out in our center. In this article, we detail the major challenges we faced with the management of antiretroviral and immunosuppressive treatments over the first 3 years post-transplant. The patient had developed dilated cardiomyopathy while on antiretroviral treatment with zidovudine, lamivudine and efavirenz. He was in WHO Stage 1 of HIV infection and had normal CD4+ count and persistently undetectable HIV-RNA. In spite of cardiac resynchronization therapy and maximal drug therapy, the patient progressed to end stage heart failure, requiring heart transplant. He was placed on a standard immune suppressive protocol including cyclosporine A and everolimus. Despite its potential pharmacokinetic interaction with efavirenz, everolimus was chosen to reduce the long-term risk of opportunistic neoplasia. Plasma levels of both drugs were monitored and remained within the target range, although high doses of everolimus were needed. There were no infectious, neoplastic or metabolic complications during a 3-year follow-up. In summary, our experience supports previous data showing that cardiac transplantation should not be denied to carefully selected HIV patients. Careful management of drug interactions and adverse events is mandatory.

DHCR7 rs12785878, CYP2R1 rs10741657, and GC rs7041 single nucleotide polymorphisms.Results: DHCR7 GG genotype (p=0.003) and the severity of fibrosis (p=0.03) were independent factors associated with lower 25(OH)D serum levels in multiple linear regression analysis.Interestingly, 53.8% (7/13) of patients with DHCR7 GG genotype had severe liver fibrosis, compared to 27.1% (67/247) of those with DHCR7 TT/TG genotype (p=0.03),By multivariate logistic regression analysis, severe fibrosis was independently associated with older age (OR, 1.056; 95% CI, 1.023-1.089,p=0.001), low cholesterol (OR, 0.984; 95% CI, 0.974-0.994,p=0.002), high triglycerides (OR, 1.008; 95% CI, 1.002-1.015,p=0.01), low 25(OH)D (OR, 0.958; 95% CI, 0.919-0.999,p=0.04),DHCR7 GG genotype (OR, 4.222; 95% CI, p=0.03), moderate-severe steatosis (OR, 2.588; 95% CI, 1.355-4.943;p=0.004), and moderate-severe necroinflammatory activity (grading) (OR, 2.437; 95% CI, p=0.001).No associations were found between liver fibrosis and both CYP2R1 and GC genotypes. Conclusion:In G1CHC patients, GG homozygosis for DHCR7 gene and lower 25(OH)D levels are independently associated with the severity of liver fibrosis.