title: Challenges and Clinical Decision-Making in HIV-to-HIV Transplantation: Insights From the HIV Literature.
abstract: Life expectancy among HIV-infected (HIV+) individuals has improved dramatically with effective antiretroviral therapy. Consequently, chronic diseases such as end-stage liver and kidney disease are growing causes of morbidity and mortality. HIV+ individuals can have excellent outcomes after solid organ transplantation, and the need for transplantation in this population is increasing. However, there is a significant organ shortage, and HIV+ individuals experience higher mortality rates on transplant waitlists. In South Africa, the use of organs from HIV+ deceased donors (HIVDD) has been successful, but until recently federal law prohibited this practice in the United States. With the recognition that organs from HIVDD could fill a critical need, the HIV Organ Policy Equity (HOPE) Act was passed in November 2013, reversing the federal ban on the use of HIV+ donors for HIV+ recipients. In translating this policy into practice, the biologic risks of using HIV+ donors need to be carefully considered. In this mini-review, we explore relevant aspects of HIV virology, antiretroviral treatment, drug resistance, opportunistic infections and HIV-related organ dysfunction that are critical to a transplant team considering HIV-to-HIV transplantation.
authors.affiliation: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: B J
authors.initials: BJ
authors.lastname: Boyarsky
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: C M
authors.initials: CM
authors.lastname: Durand
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL.
authors.forename: F J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D004197:Disease Reservoirs; D004347:Drug Interactions; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy / Q000601:surgery* / Q000635:transmission; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D010818:Practice Patterns, Physicians'; D014481:United States; D056189:Viral Tropism
chemical_list: D019380:Anti-HIV Agents
keywords: Infection and infectious agents; kidney failure/injury; liver (native) function/dysfunction; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)