Renal transplantation in HIV-infected patients: 2010 update.
The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm(3) and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft.
Internal Medicine Service, Hospital Sant Jaume Olot (Girona), Universitat de Girona, Girona, Spain.
Joan C
JC
Trullas
Federico
F
Cofan
Montse
M
Tuset
María J
MJ
Ricart
Mercedes
M
Brunet
Carlos
C
Cervera
Christian
C
Manzardo
María
M
López-Dieguez
Federico
F
Oppenheimer
Asuncion
A
Moreno
Josep M
JM
Campistol
Jose M
JM
Miro
D019380:Anti-HIV Agents / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000150:complications; D000075202:Contraindications; D004347:Drug Interactions; D005060:Europe; D006084:Graft Rejection / Q000209:etiology; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D016035:Pancreas Transplantation; D018579:Patient Selection; D017582:Renal Replacement Therapy; D014019:Tissue Donors; D014481:United States; D014850:Waiting Lists
D019380:Anti-HIV Agents; D007166:Immunosuppressive Agents