Challenges and Clinical Decision-Making in HIV-to-HIV Transplantation: Insights from the HIV Literature

B. J. Boyarsky, C. M. Durand, F. J. Palella, D. L. Segev

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)2023-2030
Number of pages8
JournalAmerican Journal of Transplantation
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2015

Keywords

  • Infection and infectious agents
  • kidney failure/injury
  • liver (native) function/dysfunction
  • viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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