Cardiac Transplantation in HIV-Positive Patients: A Narrative Review

Abstract

Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.

Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgery

“…Recently, the mechanical support and transplant community has appreciated improving clinical progress within the HIV community. 20 , 21 No longer an absolute contradiction to transplantation, patients who are HIV + are increasingly compliant with ART therapy and have low incidence of opportunistic infections. 21 Birk and colleagues 20 recently uncovered differences in data capture between the STS Adult Cardiac Surgery Database and the Interagency Registry for Mechanically Assisted Circulatory Support Database.…”

“… 20 , 21 No longer an absolute contradiction to transplantation, patients who are HIV + are increasingly compliant with ART therapy and have low incidence of opportunistic infections. 21 Birk and colleagues 20 recently uncovered differences in data capture between the STS Adult Cardiac Surgery Database and the Interagency Registry for Mechanically Assisted Circulatory Support Database. Unlike the current STS Adult Cardiac Surgery Database, the Interagency Registry for Mechanically Assisted Circulatory Support registry differentiates patients who are HIV+ from other immunocompromised patients and also includes HIV-specific variables, including CD4 count and viral load.…”