Clinical

Outcomes good after transplants in HIV-infected patients

Last Updated: 2003-11-21 16:33:37 -0400 (Reuters Health)

NEW YORK (Reuters Health) - After HIV-infected patients undergo organ transplantation, CD4 counts and viral load remain stable for at least the first year, investigators at the University of California in San Francisco report.

Prior to the availability of highly active antiretroviral therapy (HAART), some HIV-infected transplant recipients exhibited "excellent functional status and long survival periods," but disease progression appeared to be accelerated. Now, according to Dr. Michelle E. Roland and colleagues, kidney transplant and liver transplant patients on HAART have 1-year survival rates that are similar to those of uninfected recipients of nonmatched organs.

Dr. Roland's team reports their experience with 45 patients previously transplanted with liver or kidney, and two recent cases in the October issue of AIDS Patient Care and STDs.

During 2.5 years of follow-up, the patient who underwent kidney transplantation experienced infections, warts on his hands, a squamous cell carcinoma on the skin, and a high-grade squamous intraepithelial neoplasia. Prior to surgery, his CD4 count was 407 cells/�L, but later he achieved levels > 1000 cells/�L. HIV RNA levels remained undetectable.

The second patient, who underwent living-donor liver transplantation, had a relatively benign postsurgical course, developing a low-grade anal intraepithelial neoplasia that has remained stable. After 10 months, his CD4 count is > 400 cells/�L.

It does seem that HIV-infected recipients require more intense anti-rejection therapy, despite their HIV-associated immune deficits, the authors note.

They advise that living donors be advised of the potential recipient's HIV status and the unknown outcome of transplantation in such cases.

AIDS Patient Care and STDs 2003;17:501-507.