Heart transplantation in human immunodeficiency virus-positive patients.
BACKGROUND
Human immunodeficiency virus (HIV) infection is widely considered a contraindication for cardiac transplantation. However, with the newer anti-retroviral drugs, the estimated 10-year survival after seroconversion is exceeds 90%. This case series describes the intermediate range outcome of HIV-positive cardiac transplant recipients.


METHODS
A retrospective analysis of 1679 cardiac transplant patients was undertaken to identify HIV-positive recipients.


RESULTS
Seven patients were identified. Five (4 men) were diagnosed with HIV before transplantation and 2 patients seroconverted after transplantation. Dilated cardiomyopathy was the indication for transplant in all patients. The 5 HIV recipients were aged 42 +/- 8 years, and time after HIV seroconversion averaged 9.5 years. All underwent cardiac transplantation as high-risk candidates. The CD4 count was 554 +/- 169 cells/microl, and viral load was undetectable in all patients at the time of transplantation. Two patients seroconverted to HIV-positive status at 1 and 7 years after transplant. No AIDS-defining illness was observed in any patient before or after transplant. Six patients received highly active anti-retroviral therapy. Viral load remained low in the presence of immunosuppression. All patients are alive with a follow-up from transplant of 57 +/- 78.9 months.


CONCLUSIONS
Excellent intermediate term outcome is noted in carefully selected HIV-positive patients. No significant AIDS-related infections or complications occurred.
Uriel
Nir
N
Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Jorde
Ulrich P
UP
Cotarlan
Vlad
V
Colombo
Paolo C
PC
Farr
Maryjane
M
Restaino
Susan W
SW
Lietz
Katherine
K
Naka
Yoshifuma
Y
Deng
Mario C
MC
Mancini
Donna
D
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D016027:Heart Transplantation / Q000502:physiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome