Liver transplant (LT) is considered a reasonable therapeutic option for certain HIV+ patients with end-stage liver disease (ESLD). As OPTN does not collect HIV status at waitlisting, no study has examined the epidemiology of HIV+ candidates awaiting LT. We identified HIV+ candidates on the LT waiting list by linking IMS Health pharmacy data (nearly 75% of all medication refills in the US) with SRTR data, 1/1/01-10/1/12. HIV+ status was determined by >1 fill of an antiretroviral medication approved only for HIV treatment; 93% of candidates had >1 fill. Simultaneous listings were collapsed. We identified 465 HIV+ candidates on the LT waiting list. As of 2012, 76.7% of prevalent HIV+ candidates were aged 50 years or older; 62.8% were white, 23.3% African American, and 14% Hispanic. Proportions of African Americans and Hispanics were increasing; the proportion of women (<10%) was unchanged. Reasons for liver failure included HCV (46.5%) and HBV (11.6%); malignancy, alcoholic liver disease, cholestasis, and other (including non-alcoholic fatty liver disease) accounted for 41.9% of cases. Demographic characteristics of HIV+ candidates on the LT waiting list changed substantially over time. An increasing proportion were older. Racial diversity increased, but HIV+ women were rarely listed. Finally, liver malignancy and other diseases increasingly accounted for higher proportions of diagnoses than HCV- or HBV-related cirrhosis, likely reflecting an aging HIV+ population with more comorbid conditions such as diabetes and hypertension.

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