Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre‐ and post‐direct‐acting antiviral therapy eras: 10‐Year single center experience

Abstract

Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02).Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%). Conclusions:Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/ HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.

Kidney Transplantation in Patients with HIV

“…In the general transplant population, treatment of HCV infection has been associated with improved patient and allograft survival (25). One small study from Miami (26) suggests that the same is true among transplant recipients coinfected with HIV/HCV. In a cohort of 13 patients with HIV/HCV who were transplanted from 2007 to 2017, patient (100% versus 83%) and allograft (100% versus 67%) survival were significantly better in those treated with DAAs and cured of their HCV infection.…”

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

“…Treatment of HCV may be key to improving transplant outcomes for patients co‐infected with HIV/HCV. A series of 13 HIV/HCV co‐infected kidney transplant recipients from Camargo et al 26 demonstrated 100% patient and allograft survival in recipients cured of HCV after transplant, whereas patient survival was only 83% and allograft survival 67% in the pre–direct‐acting antiviral (DAA) era. The optimal timing for HCV treatment in HIV+/HCV+ patients depends mostly on the severity of liver disease and local waiting time.…”

Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

“…Contemporary cohorts of HIV-infected transplant recipients have demonstrated excellent patient and graft survival [1][2][3][4][5][6][7]. Similarly, for patients with hepatitis C virus (HCV) infection, kidney transplantation offers a survival benefit and can be more cost-effective than remaining on the waitlist [8][9][10].…”

“…In the pre-DAA era, transplantation in patients coinfected with HIV and HCV was associated with reduced graft survival and higher rates of serious infection [25]. However, recent small case series showed improved outcomes, including fewer infectious complications, in coinfected patients treated with DAA after transplant [3,4,6].…”