Need for kidney transplantation in HIV-positive individuals: results of a survey in Italy.
It is well known that HIV+individuals can be affected by end-stage renal diseases (ESRD). Despite the availability of new effective antiretroviral therapies, HIV-infected people are generally excluded from kidney transplantation, the treatment of choice for ESRD. A small number of transplantations have been performed, with encouraging data in terms of graft and patient survival. To evaluate the need of kidney transplant for HIV+individuals, we designed a multicentre study which enabled the simulation of a virtual transplant waiting list for those on dialytic treatment. In 38 participating infectious disease units, 16 HIV+patients were selected for renal replacement treatment/dialytic treatment, and they were enrolled. Clinical data were collected in order to apply general exclusion criteria and evaluate HIV clinical status. Clinical data confirmed inclusion of 7/16 patients. After application of CD4+count and HIV viraemia for further selection, the number of subjects was significantly reduced. Six patients had CD4+count greater than 200/cmm (2/6 with undetectable HIV viraemia). Only 3 patients had CD4+higher than 350/cmm (1/3 with undetectable HIV viraemia). Our data represent the first evaluation of the need and eligibility for kidney transplantation for HIV+subjects with ESRD. Application of HIV infection related parameters as selection criteria has a great strength in reducing the waiting list of HIV+subjects suitable for kidney transplant and could be carefully considered when planning inclusion/exclusion criteria for experimental purposes.
Tumietto
Fabio
F
Department of Clinical and Experimental Medicine, Section of Infectious Diseases, University of Bologna, 40138 Bologna, Italy.
Costigliola
Paolo
P
Zagnoli
Alessandra
A
Nafissi
Michele
M
Farneti
Barbara
B
Chiodo
Francesco
F
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006679:HIV Seropositivity; D019538:Health Care Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome