Alemtuzumab induction therapy in HIV-positive renal transplant recipients

HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge of the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.

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Section: Ckd Progression and Eskd In The Setting Of Hiv Infectionmentioning

confidence: 99%

Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Swanepoel

Atta

D’Agati

et al. 2018

Kidney International

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172

144

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“…In view of the increased immunological risk, some centers prefer induction therapy with an interleukin-2 receptor antagonist, polyclonal antithymocyte globulin, or alemtuzumab. 132,134,139 Tacrolimus is the calcineurin inhibitor of choice for maintenance immunosuppression. 132,140 Existing guidelines for prophylaxis against opportunistic infections 141,142 and management of hepatitis co-infection should be followed.…”

Section: Ckd Progression and Eskd In The Setting Of Hiv Infectionmentioning

confidence: 99%

Kidney Disease in the Setting of Hiv Infection: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

Сванепоэль

Atta

D’Agati

et al. 2018

Nefrologiâ (St.-Peterbg.)

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HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge o f the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.

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“… 56 In this context, current guidelines recommend using ATG for induction therapy in high immunological risk candidates. 8 , 26 Alemtuzumab, an anti-CD52 antibody, has been used as induction therapy in HIV-infected kidney transplant recipients, 57 and its use may be of particular interest for high immunological risk patients. Importantly, our results also highlight the absence of additional specific indications regarding antimicrobial prophylaxis in PLWHIV undergoing SOT.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review

Lam

Moussa

Sakr

et al. 2023

Transplantation Direct

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Background. The pharmacotherapeutic management of people living with HIV (PLWHIV) undergoing solid organ transplantation (SOT) is clinically challenging, mainly due to the frequent occurrence of complex drug–drug interactions. Although various strategies have been proposed to improve treatment outcomes in these patients, several uncertainties remain, and consensus practice guidelines are just beginning to emerge. The main objective of this scoping review was to map the extent of the literature on the pharmacotherapeutic interventions performed by healthcare professionals for PLWHIV undergoing SOT. Methods. We searched Medline, Embase, and the Cochrane databases as well as gray literature for articles published between January 2010 and February 2020. Study selection was performed by at least 2 independent reviewers. Articles describing pharmacotherapeutic interventions in PLWHIV considered for or undergoing SOT were included in the study. Results. Of the 12 599 references identified through our search strategy, 209 articles met the inclusion criteria. Results showed that the vast majority of reported pharmacotherapeutic interventions concerned the management of immunosuppressive and antimicrobial therapy, including antiretrovirals. Analysis of the data demonstrated that for several aspects of the pharmacotherapeutic management of PLWHIV undergoing SOT, there were differing practices, such as the choice of immunosuppressive induction and maintenance therapy. Other important aspects of patient management, such as patient counseling, were rarely reported. Conclusions. Our results constitute an extensive overview of current practices in the pharmacotherapeutic management of SOT in PLWHIV and identify knowledge gaps that should be addressed to help improve patient care in this specific population.

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Alemtuzumab induction therapy in HIV-positive renal transplant recipients

Cited by 7 publications

References 8 publications

Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Kidney Disease in the Setting of Hiv Infection: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review

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