Evaluating Challenges in Access To Transplantation for Persons with HIV

Area of Science:

• Transplantation immunology
• Infectious disease epidemiology
• Public health policy

Background:

• Antiretroviral therapy has increased life expectancy for people with HIV (PWH), leading to more end-stage organ diseases.
• PWH with end-stage disease have a higher mortality risk, underscoring the need for improved organ transplant access.
• Organ transplantation is a critical, life-saving therapy for PWH with end-stage organ failure.

Purpose of the Study:

• To review the barriers hindering organ transplantation for PWH.
• To analyze these barriers using a modified five A's model: acceptability, availability, accessibility, affordability, and accommodation.
• To identify strategies for improving organ transplant access for PWH.

Main Methods:

• Literature review of studies on organ transplantation for PWH.
• Application of a modified five A's framework to categorize identified barriers.
• Synthesis of findings to provide a comprehensive overview of challenges and potential solutions.

Main Results:

• PWH are less likely to receive organ transplants than the general population, despite similar post-transplant outcomes.
• The HIV Organ Policy and Equity (HOPE) Act expanded the donor pool for HIV-to-HIV transplants, but challenges remain.
• Policy, logistical constraints, and HIV-related stigma are significant barriers limiting transplant access for PWH.

Conclusions:

• Multilevel challenges persist in expanding organ transplantation for PWH.
• Addressing policy, stigma, and logistical barriers is essential for equitable access.
• Improving organ transplant access for PWH is crucial for improving survival and quality of life.