Raltegravir in Patients With End Stage Liver Disease and in Transplant Recipients

Inclusion Criteria: * Age ≥ 18 * Documented HIV-1 infection, hepatitis B or C co-infection is allowed * Plasma viral load at screening visit below 50 copies per mL for at least 6 months * Patient with severe liver failure (Meld Score ≥ 15 and/or refractory ascites and/or haemorrhage of digestive tract and/or hepatic encephalopathy) for taking part into period 1 * Patient eligible for the liver transplant waiting list or immediate post transplantation for taking part into period 2 * Abstinence from alcohol intake for at least 6 months (WHO norm) * Withdrawal from intravenous drug use for at least 6 months (methadone substitution is permitted) * No ongoing class C opportunistic infection (1993 CDC classification) * Patient whose clinical and immunovirological condition allows triple therapy with raltegravir + 2 NRTI or raltegravir + NRTI + enfuvirtide * Patient whose HIV population, according to cumulative genotypes carried out on viral RNA together with treatment history (if available and interpreted as per the ANRS-AC11 algorithm version no.19) does not present a profile of mutations associated with resistance to raltegravir and is sensitive to at least two fully active\* agents selected among nucleoside/nucleotide reverse transcriptase analogs NRTI (abacavir, lamivudine, emtricitabine, tenofovir) or enfuvirtide \*An ARV agent is considered to be fully active if the cumulative genotypes do not show any mutation associated with resistance or any mutation associated with "possible resistance" * Patient not having experienced viral escape during treatment combining 3TC, FTC or raltegravir * Patient registered with or covered by a social security scheme * For women of child-bearing potential, use of a barrier contraceptive method during sexual intercourse and negative pregnancy test (plasma ß-HCG ) at screening visit * Informed consent form signed at screening visit at the latest Exclusion Criteria: * More than two virological failures during antiretroviral treatment * Currently receiving treatment with an agent in development (apart from an authorization for temporary use) * Plasma viral load at screening visit ≥ 50 copies per mL during at least the last 6 months * Pregnant women, or women liable to become pregnant, breast-feeding women, no contraception, or refusal to use contraception * All conditions (including but not limited to alcohol intake and drug use) liable to compromise, in the investigator's opinion, the safety of treatment and/or the patient's compliance with the protocol * Patient not having any effective options for NRTI +/- enfuvirtide (defined in the inclusion criteria) * Ongoing treatment with interferon-alpha or ribavirin for hepatitis C * Concomitant medication including one or more agents liable to induce UGT1A1 and reduce raltegravir concentrations: * anti-infective agents: rifampicin/rifampin * psychotropic/antiepileptic agents: phenytoin, phenobarbital, carbamazepine * steroidal anti-inflammatory drug: dexamethasone