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

William A. Werbel, Christine M. Durand

Research output: Contribution to journalReview article

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. Summary: 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.

Original languageEnglish (US)
Pages (from-to)191-203
Number of pages13
JournalCurrent HIV/AIDS reports
Volume16
Issue number3
DOIs
StatePublished - Jun 15 2019

Keywords

  • HIV
  • Hepatitis C
  • Immunosuppression
  • Kidney
  • Liver
  • Rejection
  • Transplantation

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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