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Review
. 2019 Jun;16(3):191-203.
doi: 10.1007/s11904-019-00440-x.

Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers

William A Werbel  1 , Christine M Durand  2   3
Affiliations
Review

Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers

William A Werbel et al. Curr HIV/AIDS Rep. 2019 Jun.

Abstract

Purpose of review: End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers.

Recent findings: HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.

Keywords: HIV; Hepatitis C; Immunosuppression; Kidney; Liver; Rejection; Transplantation.

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Conflict of interest statement

Conflict of Interest

Drs. William Werbel and Christine Durand declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Assessment and Monitoring of the HIV-infected Solid Organ Transplant Candidate
This figure presents an abridged approach to pre-transplant risk stratification and management of HIV+ SOT patients, including immunosuppression and prophylaxis considerations. Light grey boxes denote standard HIV+ SOT practices whereas the darker grey boxes pertain to HIV D+/R+ SOT and other investigational protocols. Abbreviations APOL1 denotes apolipoprotein L1, ATG anti-thymocyte globulin, c/ml copies/milliliter, CMV cytomegalovirus, CNI calcineurin inhibitor, D+/R+ donor and recipient positive, DAA direct-acting antiviral, HBV hepatitis B virus, HCV hepatitis C virus, HPV human papilloma virus, INSTI integrase strand transfer inhibitor, MTOR mammalian target of rapamycin, NAT nucleic acid test, OI opportunistic infection, PJP Pneumocystis jirovecii, SOT solid organ transplant
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). (2018). Global HIV & AIDS statistics - 2018 fact sheet. Available: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_e.... Accessed: 5 August, 2018.
    1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report. 2018;23(1).
    1. Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017;18(4):256–66. - PubMed
    1. Wandeler G, Johnson LF, Egger M. Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Curr Opin HIV AIDS. 2016;11(5):492–500. - PMC - PubMed
    1. Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384(9939):241–8. - PubMed

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