Solid organ transplantation in HIV-infected individuals
- Pablo Tebas, MD
Pablo Tebas, MD
- Professor of Medicine
- University of Pennsylvania
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
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 HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)
Prior to the availability of a reliable diagnostic test for 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].
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- OUTCOMES BEFORE HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)
- Overview of medical literature
- SOLID ORGAN TRANSPLANTATION IN THE HAART ERA
- Liver transplantation
- Renal transplantation
- Heart transplantation
- CHEMOKINE RECEPTORS, TRANSPLANTATION, AND HIV INFECTION
- PHARMACOLOGIC ASPECTS AFTER TRANSPLANTATION
- VIRAL HEPATITIS RECURRENCE AFTER TRANSPLANTATION
- OTHER COMPLICATIONS AFTER SOLID ORGAN TRANSPLANTATION
- CURRENT TRANSPLANT ELIGIBILITY CRITERIA IN THE UNITED STATES
- SUMMARY AND RECOMMENDATIONS