Hope for kidney transplantation in candidates with human immunodeficiency virus

Kidney transplantation continues to be the kidney replacement therapy of choice for patients with end stage kidney disease (ESKD) associated with a survival benefit over remaining on dialysis. Patients living with both ESKD and human immunodeficiency virus (HIV) have traditionally faced barriers accessing the kidney transplant (KT) waiting list given need for special considerations in addition to general listing requirements for KT candidates. The HIV Organ Policy Equity (HOPE) Act in 2013 and HOPE Act Variance in 2015 restricted HIV positive donor (+D) to HIV positive recipient (+R) transplants to research protocols or Institutional Review Board approved programs. Federal regulatory changes in 2024-2025 removed the above restrictions making HIV +D to HIV +R KTs standard of care practice for approved centers. Removal of the research criteria requirements in alignment with federal regulatory changes will likely expand access so that more individuals living with HIV can obtain a KT. Herein we will provide a narrative review of the available literature in the PubMed database on studies completed under the HOPE act as well as the special considerations in evaluating HIV positive renal transplant candidates and their subsequent post-transplant care to help ensure clinician and patient comfort in this era.