Challenges and Clinical Decision-Making in HIV-to-HIV Transplantation: Insights From the HIV Literature

被引:50
作者
Boyarsky, B. J. [1 ]
Durand, C. M. [2 ]
Palella, F. J., Jr. [3 ]
Segev, D. L. [1 ,4 ]
机构
[1] Johns Hopkins Sch Med, Dept Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Sch Med, Dept Med, Baltimore, MD USA
[3] Northwestern Univ, Feinberg Sch Med, Dept Med, Chicago, IL 60611 USA
[4] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
关键词
ANTIRETROVIRAL DRUG-RESISTANCE; INFECTIOUS-DISEASES-SOCIETY; CHRONIC KIDNEY-DISEASE; UNITED-STATES; RENAL-TRANSPLANTATION; MEDICINE ASSOCIATION; LATENT RESERVOIR; TROPIC VIRUS; LIVER; THERAPY;
D O I
10.1111/ajt.13344
中图分类号
R61 [外科手术学];
学科分类号
摘要
Life expectancy among HIV-infected (HIV+) individuals has improved dramatically with effective antiretroviral therapy. Consequently, chronic diseases such as end-stage liver and kidney disease are growing causes of morbidity and mortality. HIV+ individuals can have excellent outcomes after solid organ transplantation, and the need for transplantation in this population is increasing. However, there is a significant organ shortage, and HIV+ individuals experience higher mortality rates on transplant waitlists. In South Africa, the use of organs from HIV+ deceased donors (HIVDD) has been successful, but until recently federal law prohibited this practice in the United States. With the recognition that organs from HIVDD could fill a critical need, the HIV Organ Policy Equity (HOPE) Act was passed in November 2013, reversing the federal ban on the use of HIV+ donors for HIV+ recipients. In translating this policy into practice, the biologic risks of using HIV+ donors need to be carefully considered. In this mini-review, we explore relevant aspects of HIV virology, antiretroviral treatment, drug resistance, opportunistic infections and HIV-related organ dysfunction that are critical to a transplant team considering HIV-to-HIV transplantation.
引用
收藏
页码:2023 / 2030
页数:8
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