title: Infections in solid organ transplant HIV-infected patients.
abstract: Solid organ transplantation (SOT) is an appropriate therapeutic option for HIV-infected patients with end-stage organ disease. Recent experience in North America and Europe indicates that 3- to 5-year survival in HIV/HCV-coinfected liver recipients is lower than that of HCV-monoinfected recipients. Conversely, 3- to 5-year survival of non-HCV-coinfected transplant patients (liver, kidney and heart) was similar to that of non-HIV-infected patients. Preliminary experience with lung transplantation and combined kidney and pancreas transplantation is also satisfactory. Infections in HIV-infected recipients during the post-transplant period are similar to those seen in non-HIV-infected patients, although the incidence rates of tuberculosis and fungal infections seem to be higher. HIV-infected patients who are being evaluated for SOT should follow the same recommendations as those used for non-HIV-infected patients in order to prevent infections during the pre-transplant period. After transplantation, HIV-infected SOT recipients must follow recommendations on post-SOT and anti-HIV immunization and on antimicrobial prophylaxis. The recommended antiretroviral regimen is one based on raltegravir or dolutegravir plus two nucleos(t)ide reverse transcriptase inhibitors (tenofovir + emtricitabine or abacavir + lamivudine), because it can prevent pharmacokinetic interactions between antiretroviral drugs, immunosuppressive drugs and some of the antimicrobial agents used to treat or prevent post-transplant infections. In this manuscript, we review current recommendations for preventing infections both before and after transplantation. We also analyse the incidence, aetiology and clinical characteristics of opportunistic and non-opportunistic bacterial, mycobacterial, fungal and viral infections in HIV-infected SOT recipients during the post-transplant period.
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.forename: F
authors.initials: F
authors.lastname: Agüero
authors.forename: J-C
authors.initials: JC
authors.lastname: Duclos-Vallée
authors.forename: N J
authors.initials: NJ
authors.lastname: Mueller
authors.forename: P
authors.initials: P
authors.lastname: Grossi
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D005060:Europe; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D009656:North America; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D016377:Organ Transplantation; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents
keywords: End-stage organ disease; HIV/AIDS; hepatitis B virus; hepatitis C virus; highly active antiretroviral therapy; infections; prophylaxis of opportunistic infections; solid organ transplantation