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Solid Organ Transplantation for HIV-Infected Individuals.
Ashton A Shaffer1,2, Christine M Durand3,4
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Current Treatment Options in Infectious Diseases
|July 7, 2018
Summary
Solid organ transplantation is a viable option for individuals with well-controlled HIV. Infectious disease specialists can optimize care for HIV+ transplant recipients, ensuring excellent outcomes and managing potential complications like rejection and drug interactions.
Area of Science:
- Immunology
- Infectious Diseases
- Transplantation Medicine
Background:
- End-stage organ disease is rising in HIV-infected (HIV+) individuals.
- Appropriate HIV+ candidates have controlled HIV on antiretroviral therapy (ART), no active infections/cancer, and adequate CD4 counts.
Purpose of the Study:
- To review the role of infectious disease clinicians in managing HIV+ organ transplant candidates.
- To highlight outcomes and considerations for HIV+ solid organ transplantation.
Main Methods:
- Review of clinical trials and registry-based studies.
- Analysis of patient and graft survival rates.
- Examination of allograft rejection and infection rates.
Main Results:
- HIV+ kidney and liver transplant recipients show excellent outcomes, comparable to HIV-uninfected patients.
- Elevated allograft rejection rates in HIV+ individuals may stem from immune dysregulation or drug interactions.
- Lymphocyte-depleting immunosuppression shows promise in reducing rejection without increasing infections.
Conclusions:
- Solid organ transplantation should be considered for eligible HIV+ individuals with end-stage organ disease.
- Infectious disease clinicians play a crucial role in optimizing ART and managing immunosuppression to avoid drug interactions.
- Hepatitis C virus (HCV) coinfection outcomes are improving with direct-acting antivirals, and organs from HIV+ donors are now a consideration for HIV+ recipients.
Keywords:
HIV infectionend-stage liver diseaseend-stage renal diseaseimmunosuppressionkidney transplantliver transplantsolid organ transplantationMore Related Videos
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