Kidney transplantation in patients with HIV infection

HIV infection is a common cause of ESRD, particularly among blacks. Advances in antiretroviral therapy have greatly improved the survival of HIV patients, including those with renal disease. Despite concerns about the risk of immunosuppressive medications for HIV patients, emerging studies have now reported acceptable short-term outcomes for eligible HIV recipients undergoing renal transplantation, and an ongoing multicenter clinical trial reported 1-year patient and graft survival similar to that of HIV-uninfected kidney recipients. In these studies, the interactions between calcineurin inhibitors and HIV medications that are also metabolized by the cytochrome P450 system required substantial dosing modifications and careful monitoring of calcineurin inhibitor trough levels. These studies also revealed an elevated risk of acute rejection of the kidney allograft but few reports of opportunistic infections or viremia that could not be controlled. Long-term follow-up studies will be important to examine these outcomes and the development of malignancy to fully evaluate the risk and benefits of kidney transplantation among HIV-positive recipients.