Liver, kidney, and heart transplantation are the current treatments of choice for advanced organ failure. However, human immunodeficiency virus (HIV) infection was traditionally considered an absolute contraindication for transplantation . One of the principal concerns was that immunosuppression would accelerate HIV/acquired immune deficiency syndrome (AIDS), resulting in increased mortality and a "waste" of organs. (See "Evaluation of the potential renal transplant recipient".)
Since highly active antiretroviral therapy (HAART) became widely available in 1996, the prognosis of HIV infection has dramatically improved. There have been significant decreases in morbidity and mortality, and, for many individuals with well-controlled viral replication, HIV/AIDS is now a chronic, manageable disease . (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient".)
Previously, HIV-infected individuals with very advanced disease frequently died from opportunistic infections (OIs). Among such individuals, the presence of chronic diseases, such as renal insufficiency, coronary artery disease, diabetes mellitus, or liver failure (associated with hepatitis B [HBV] or C virus [HCV] coinfection), were not significant causes of mortality. The situation is currently quite different as these comorbidities, as well as others, are real medical problems for many individuals with well-controlled HIV replication [3-6].
Such improvements in the long-term prognosis of those with HIV infection have prompted many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. A review of the issues surrounding solid organ transplantation in HIV-infected patients is presented here.
OUTCOMES BEFORE HAART
Prior to the availability of a reliable diagnostic test for human immunodeficiency virus (HIV) infection, some individuals unknowingly infected with HIV underwent solid organ transplantation [7-11]. Others acquired HIV infection by receiving an organ from a HIV-positive individual [12-18].