How Feasible Is Renal Transplantation in HIV-Infected Patients?

HIV infection has been considered for a long time an absolute contraindication to transplantation. The introduction of highly active antiretroviral therapy has led to improved immunovirological control and increased survival in HIV-infected patients. Renal transplantation can now be performed if these patients are on stable highly active antiretroviral therapy and achieve undetectable viral load and a sufficient CD4 level, in the absence of untreatable infections and cancers. Highly active antiretroviral therapy and immunosuppressive medication should be maintained for life in these patients, raising the problem of multiple drugdrug interactions. Thus, an increased rate of rejection was attributed to the difficulty of achieving sufficient immunosuppressive levels but also to the intrinsic immune system activation despite suppressed HIV RNA levels. HIV infection of the kidney allograft could constitute a renal viral reservoir that impacts long term graft survival. Future options are developing, such as transplanting organs from HIV-infected donors. With highly active antiretroviral therapy, patient and graft survival in HIV-infected kidney transplant recipients are improving and approaching that of non-infected controls.