title: The Times, They are a-Changing: HOPE for HIV-to-HIV Organ Transplantation.
abstract: HIV-infected persons who achieve undetectable viral loads on antiretroviral therapy currently have near-normal lifespans. Liver disease is a major cause of non-AIDS-related deaths, and as a result of longer survival, the prevalence of end-stage renal disease in HIV is increasing. HIV-infected persons undergoing organ transplantation generally achieve comparable patient and graft survival rates compared to their HIV-uninfected counterparts, despite a nearly threefold increased risk of acute rejection. However, the ongoing shortage of suitable organs can limit transplantation as an option, and patients with HIV have higher waitlist mortality than others. One way to solve this problem would be to expand the donor pool to include HIV-infected individuals. The results of a South Africa study involving 27 HIV-to-HIV kidney transplants showed promise, with 3- and 5-year patient and graft survival rates similar to those of their HIV-uninfected counterparts. Similarly, individual cases of HIV-to-HIV liver transplantation from the United Kingdom and Switzerland have also shown good results. In the United States, HIV-to-HIV kidney and liver transplants are currently permitted only under a research protocol. Nevertheless, areas of ambiguity exist, including streamlining organ allocation practices, optimizing HIV-infected donor and recipient selection, managing donor-derived transmission of a resistant HIV strain, determining optimal immunosuppressive and antiretroviral regimens, and elucidating the incidence of rejection in HIV-to-HIV solid organ transplant recipients.
authors.affiliation: 1 Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA. 2 University of Pittsburgh and VA Pittsburgh Healthcare System, Infectious Diseases Section, Pittsburgh, PA.
authors.forename: Ghady
authors.initials: G
authors.lastname: Haidar
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D046148:Donor Selection; D005838:Genotype; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006678:HIV / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000635:transmission / Q000821:virology; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents