Clinical

Good transplant outcomes possible in HIV-infected patients

Last Updated: 2007-09-19 14:48:03 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A number of centers have eliminated HIV infection as a contraindication to transplantation, and findings from a new review suggest that transplant outcomes can be good in HIV-infected recipients.

In a study of liver transplantation, HIV-positive recipients had a 3-year cumulative survival rate on a par with their uninfected peers -- 73% vs. 78% -- researchers Drs. Peter G. Stock and Michelle E. Roland, from the University of California at San Francisco, note in the September 15th issue of Transplantation.

Kidney transplantation results have also been good in HIV-positive recipients. One-year graft survival rates are generally comparable to those seen in HIV-negative populations and in one study, 100% survival was seen at an average follow-up period of 480 days.

Dr. Stock and Dr. Roland note there is little evidence that either type of transplantation hastens the progression of HIV disease.

Selection criteria are important in achieving optimal patient outcomes, the report indicates. Key factors to consider include the absolute CD4+ T cell count and the extent of viremia.

Following transplantation, attention must be paid to immunosuppressive therapy, what agents to use for HAART, and possible drug interactions, the authors say. Control of hepatitis B and C virus coinfections is also a must as is prophylaxis against opportunistic infections.

"The blanket exclusion of HIV-infected patients can no longer be justified based on the early results demonstrating the safety and efficacy of transplantation in this group of patients," the researchers conclude. "It is imperative that HIV-positive patients, HIV healthcare providers, and the transplant community are aware that transplant is a viable option for the HIV-infected patient."

Transplantation 2007;84:563-571.