Human Immunodeficiency Virus in Kidney Transplantation

Area of Science:

• Nephrology
• Infectious Diseases
• Transplant Surgery

Background:

• Highly active antiretroviral therapy has improved longevity for human immunodeficiency virus (HIV)-infected individuals.
• End-stage renal disease (ESRD) is a growing concern for the aging HIV-positive population.
• HIV is no longer a contraindication for solid-organ transplantation, including kidney transplants.

Purpose of the Study:

• To review the current status and outcomes of kidney transplantation in HIV-infected patients.
• To identify challenges and potential solutions in HIV-infected kidney transplant recipients.
• To explore the role of HIV-positive to HIV-positive kidney transplantation.

Main Methods:

• Literature review of kidney transplantation in HIV-infected populations.
• Analysis of outcomes, including acute rejection and graft survival.
• Discussion of drug-drug interactions and co-infections (e.g., Hepatitis C).

Main Results:

• Kidney transplantation outcomes in HIV-infected patients are generally excellent.
• Significant challenges include high rates of acute rejection and complex drug-drug interactions.
• Co-infection with Hepatitis C virus is associated with poorer outcomes.
• HIV-positive to HIV-positive kidney transplantation is an emerging strategy.

Conclusions:

• Kidney transplantation is a safe and effective option for select HIV-infected patients with ESRD.
• Ongoing research and clinical practice aim to mitigate challenges like rejection and drug interactions.
• Innovations such as HIV-positive to HIV-positive transplantation may help address organ shortages.