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An Update on Heart Transplantation in Human Immunodeficiency Virus-Infected Patients
F Agüero1, M A Castel2, S Cocchi3
1Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Insights
Heart transplantation (HT) is a viable option for patients with end-stage heart failure (ESHF) and human immunodeficiency virus (HIV). Effective combined antiretroviral therapy (cART) enables successful outcomes for selected HIV-infected individuals undergoing HT.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Cardiovascular diseases are a major cause of illness in human immunodeficiency virus (HIV)-infected patients.
- Heart transplantation (HT) is a treatment for end-stage heart failure (ESHF), including in select HIV-infected individuals.
- Limited data exist on HT outcomes in HIV-infected patients on combined antiretroviral therapy (cART).
Purpose of the Study:
- To review epidemiological data on ESHF in HIV-infected patients.
- To discuss practical management strategies for HIV-infected patients undergoing HT.
- To identify pre- and post-transplant challenges and future research priorities.
Main Methods:
- Systematic review of published literature on HT in HIV-infected patients.
- Analysis of epidemiological data since the HIV epidemic's onset.
- Discussion of clinical management based on current evidence.
Main Results:
- HIV-infected patients on effective cART demonstrate satisfactory outcomes post-HT.
- HIV-related events are not prevalent in HT recipients with HIV on cART.
- Many centers still consider HIV a contraindication, despite positive outcomes.
Conclusions:
- Selected HIV-infected patients with ESHF on effective cART should be considered for HT.
- Careful pre- and post-transplant management is crucial for successful outcomes.
- Further research is needed to optimize HT protocols for this population.
Abstract:
Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.
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