Transplantation in the HIV+ patient

The historical exclusion from transplantation of HIV-infected people was based on the logical premise that immunosuppression required for organ transplantation would exacerbate an immunocompromised state. However, the prognosis for people with HIV infection has dramatically improved with the clinical use of highly active antiretroviral (ARV) therapy (HAART). Clinical trials of ARV agents have demonstrated significant virologic, immunologic and survival benefits associated with the use of protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) containing regimens, when combined with two nucleoside analogues. The incidence of opportunistic infections and hospitalizations has decreased with the use of HAART. In combination with historical data suggesting that a subpopulation of HIV+ transplant recipients tolerate immunosuppression and have allograft survival comparable to that of HIV- transplant recipients, these results indicate that the medical community should readdress HIV infection as a contraindication to transplantation.