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  • Review Article
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Renal transplantation in patients with HIV

Nature Reviews Nephrology volume 5, pages 582–589 (2009)Cite this article

Abstract

HIV infection has been a major global health problem for almost three decades. With the introduction of highly active antiretroviral therapy in 1996, and the advent of effective prophylaxis and management of opportunistic infections, AIDS mortality has decreased markedly. In developed countries, this once fatal infection is now being treated as a chronic condition. As a result, rates of morbidity and mortality from other medical conditions leading to end-stage liver, kidney and heart disease are steadily increasing in individuals with HIV. Presence of HIV infection used to be viewed as a contraindication to transplantation for multiple reasons: concerns for exacerbation of an already immunocompromised state by administration of additional immunosuppressants; the use of a limited supply of donor organs with unknown long-term outcomes; and, the risk of viral transmission to the surgical and medical staff. This Review examines open questions on kidney transplantation in patients infected with HIV-1 and clinical strategies that have resulted in good outcomes. It also describes the clinical concerns associated with the treatment of renal transplant recipients with HIV.

Key Points

  • Renal transplantation is both safe and effective in patients with HIV

  • Rejection rates in patients with HIV are increased, although these rejections respond to therapy

  • Several interactions between highly active antiretroviral therapy drugs and immunosuppressants exist, and they should be taken into careful consideration when devising immunosuppression regimens

  • Management of co-infection with hepatitis C virus and HIV is challenging, as progression rate of liver disease is increased in affected patients

  • Treatment and patient oversight by a team of specialists is critically important to the management of renal transplant recipients with HIV

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Acknowledgements

Drs. Frassetto and Stock receive support from NIH NIAID grant AI052748, “Solid Organ Transplantation in HIV”.

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Medicine and Clinical Research Center University of California San Francisco, CA, USA

    Lynda A. Frassetto

  2. Department of Surgery, University of California San Francisco, CA, USA

    Clara Tan-Tam & Peter G. Stock

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  1. Lynda A. Frassetto
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Correspondence to Lynda A. Frassetto.

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Frassetto, L., Tan-Tam, C. & Stock, P. Renal transplantation in patients with HIV. Nat Rev Nephrol 5, 582–589 (2009). https://doi.org/10.1038/nrneph.2009.140

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