Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers

被引:25
作者
Werbel, William A. [1 ]
Durand, Christine M. [1 ,2 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Med, 725 North Wolfe St,PCTB Room 228, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Sidney Kimmel Canc Ctr, Baltimore, MD 21205 USA
关键词
HIV; Transplantation; Kidney; Liver; Hepatitis C; Rejection; Immunosuppression; HUMAN-IMMUNODEFICIENCY-VIRUS; COINFECTED LIVER-TRANSPLANT; STAGE RENAL-DISEASE; KIDNEY-TRANSPLANTATION; HEPATITIS-C; ANTIRETROVIRAL THERAPY; ALLOGRAFT-REJECTION; POSITIVE PATIENTS; PROTEASE INHIBITOR; CLINICAL-OUTCOMES;
D O I
10.1007/s11904-019-00440-x
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Purpose of ReviewEnd-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers.Recent FindingsHIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation.SummarySOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
引用
收藏
页码:191 / 203
页数:13
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