[Renal transplantation in patients with HIV infection].
The prevalence of human immunodeficience virus (HIV) infection among patients under renal replacement therapy varies, with estimates of 1% for Europe and 1.5% for the United States. Survival in HIV infected individuals receiving renal replacement therapy has improved since the introduction of high activity antiretroviral therapy (HAART). Current experience in renal transplantation in HIV-infected patients in the United States indicates that the three-year survival rate is similar to that of HIV-negative transplant recipients, with virological and immunological control of the infection by HAART and no increase in the number of opportunistic infections or tumors. The criteria for selecting renal transplantation candidates in this population are the following: no aids-defining events, CD4 cells > 200 cells/.l and undetectable viral load under HAART. In Spain, where most of these patients are former drug abusers, a two-year period of abstinence from cocaine and heroine abuse is also required, although patients can be participating in the methadone program. The main problems in the post-transplantation period have been interactions between HAART and immunosuppressive drugs, management of hepatitis C virus (HCV) coinfection and the high rate of acute rejection. To date, seven such renal transplantations have been performed in Spain, with favorable patient and graft survival and no progression to aids.
Trullás
Joan-Carles
JC
Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
Miró
José M
JM
Barril
Guillermina
G
Ros
Silvia
S
Burgos
Francisco-Javier
FJ
Moreno
Asunción
A
Mazuecos
Auxiliadora
A
Alvarez-Vijande
Ricardo
R
Oppenheimer
Federico
F
Carmen Sánchez
M
M
Blanco
José L
JL
Tuset
Montserrat
M
Torre-Cisneros
Julián
J
Polo
Rosa
R
González
Juan
J
D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D000075202:Contraindications; D004347:Drug Interactions; D005060:Europe / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D015528:HIV Seroprevalence; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000941:ethics / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D008017:Life Expectancy; D018579:Patient Selection; D006435:Renal Dialysis; D013030:Spain; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D019380:Anti-HIV Agents; D007166:Immunosuppressive Agents