Current status of kidney transplantation in HIV-infected patients

Sawinski, Deirdre; Bloom, Roy D.

doi:10.1097/mnh.0000000000000071

Cited by 10 publications

(13 citation statements)

References 29 publications

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“…Currently, 2 main approaches have been proposed to address this issue. First, dose finding and pharmacokinetics studies have been conducted with promising results in predicting post-transplant TAC levels (31,32), and second, it is suggested that HIV-infected patients have their ARV regimen changed before transplantation, switching candidates to an integrase-based regimen (33). As previously reported, the incidence of DGF after deceased-donor kidney transplantation is very high in Brazilian transplant centers, and this was also observed in this study (13,14).…”

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Renal transplantation in human immunodeficiency virus‐infected recipients: a case–control study from the Brazilian experience

Vicari

Spuldaro

Sandes-Freitas

et al. 2016

Transplant Infectious Dis

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Renal transplantation in human immunodeficiency virus‐infected recipients: a case–control study from the Brazilian experience

Vicari

Spuldaro

Sandes-Freitas

et al. 2016

Transplant Infectious Dis

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“…This epidemiological shift translates into a continuous rise in non-AIDSrelated ICU admissions which broadly exceeded those for severe OIs in most of recent cohorts. Furthermore, on the basis of encouraging outcomes, HIV infection is no longer a definite contra-indication for SOT in patients with chronic kidney, liver or heart failure, thereby enlarging the scope of critical illnesses in this population [25][26][27].…”

Section: The Current Landscape Of Hiv Infection In the Icumentioning

confidence: 99%

Management of HIV-infected patients in the intensive care unit

et al. 2020

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The widespread use of combination antiretroviral therapies (cART) has converted the prognosis of HIV infection from a rapidly progressive and ultimately fatal disease to a chronic condition with limited impact on life expectancy. Yet, HIV-infected patients remain at high risk for critical illness due to the occurrence of severe opportunistic infections in those with advanced immunosuppression (i.e., inaugural admissions or limited access to cART), a pronounced susceptibility to bacterial sepsis and tuberculosis at every stage of HIV infection, and a rising prevalence of underlying comorbidities such as chronic obstructive pulmonary diseases, atherosclerosis or non-AIDS-defining neoplasms in cART-treated patients aging with controlled viral replication. Several patterns of intensive care have markedly evolved in this patient population over the late cART era, including a steady decline in AIDS-related admissions, an opposite trend in admissions for exacerbated comorbidities, the emergence of additional drivers of immunosuppression (e.g., anti-neoplastic chemotherapy or solid organ transplantation), the management of cART in the acute phase of critical illness, and a dramatic progress in short-term survival that mainly results from general advances in intensive care practices. Besides, there is a lack of data regarding other features of ICU and post-ICU care in these patients, especially on the impact of sociological factors on clinical presentation and prognosis, the optimal timing of cART introduction in AIDS-related admissions, determinants of end-of-life decisions, long-term survival, and functional outcomes. In this narrative review, we sought to depict the current evidence regarding the management of HIV-infected patients admitted to the intensive care unit.

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19] At the time of this finding, this poor renal outcome was possibly, in part, due to a higher rate of acute rejection of PLHIV because of insufficient induction therapy. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Indeed, the importance of T cell depleting induction in PLHIV has only recently been established. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression. The possible interactions between antiretroviral and immunosuppressive drugs requiring complex drug monitoring 24,25 might also be a disincentive.…”

Section: Introductionmentioning

confidence: 99%

Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study

Tourret

Guiguet

Lassalle

et al. 2019

American Journal of Transplantation

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We compared access to a kidney transplantation (KT) waiting list (WL) and to KT between people living with HIV (PLHIV) and HIV‐uninfected controls. Using the REIN (the national Renal Epidemiology and Information Network registry), we included all PLHIV initiating dialysis in France throughout 2006‐2010 and HIV‐uninfected controls matched for age, sex, year of dialysis initiation, and the existence of a diabetic nephropathy. Patients were prospectively followed until December 2015. We used a competitive risk approach to assess the cumulative incidence of enrollment on WL and of KT, with death as a competing event (subdistribution hazard ratio adjusted on comorbidities, asdHR). There were 255 PLHIV in the REIN (median age 47 years) of whom 180 (71%) were also found in the French Hospital Database on HIV (FHDH‐ANRS CO4) including 126 (70%) known to be on antiretroviral therapy with HIV viral suppression (VS). Five years after dialysis initiation, 65%, and 76%, of treated PLHIV with VS, and of HIV‐uninfected controls were enrolled on a WL (asdHR 0.68; 95% CI 0.50‐0.91). Access to KT was also less frequent and delayed for treated PLHIV with VS (asdHR 0.75, 95% CI, 0.52‐1.10). PLHIV continue to face difficulties to access KT.

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Current status of kidney transplantation in HIV-infected patients

Abstract: Renal transplantation remains the optimal treatment for end stage renal disease in the HIV-infected patient.

Cited by 10 publications

References 29 publications

Renal transplantation in human immunodeficiency virus‐infected recipients: a case–control study from the Brazilian experience

Renal transplantation in human immunodeficiency virus‐infected recipients: a case–control study from the Brazilian experience

Management of HIV-infected patients in the intensive care unit

Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study

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