Details

Autor(en) / Beteiligte

• Shaffer, Ashton A.
• Durand, Christine M.

Titel

Solid Organ Transplantation for HIV-Infected Individuals

Ist Teil von

• Current treatment options in infectious disease, 2018-03, Vol.10 (1), p.107-120

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2018

Link zum Volltext

Quelle

SpringerLink (Online service)

Beschreibungen/Notizen

• Purpose of review The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant. Recent findings Clinical trials and registry-based cohort studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with patient and graft survival similar to HIV-uninfected patients. Elevated allograft rejection rates have been observed in HIV+ individuals; this may be related to a dysregulated immune system, drug interactions, or both. Lymphocyte-depleting immunosuppression has been associated with lower rejection rates without increased infections using national registry data. Hepatitis C virus (HCV) co-infection has been associated with worse outcomes; however, improvements are expected with direct-acting antiviral therapies. Summary Solid organ transplantation should be considered for HIV+ individuals with end-stage organ disease. Infectious disease clinicians can optimize ART to avoid pharmacoenhancers, which interact with immunosuppression. The timing of HCV treatment (pre- or post-transplant) should be discussed with the transplant team. Finally, organs from HIV+ donors can now be considered for HIV+ transplant candidates, within research protocols.