Erschienen in:
16.05.2019 | HIV Pathogenesis and Treatment (AL Landay and NS Utay, Section Editors)
Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers
verfasst von:
William A. Werbel, Christine M. Durand
Erschienen in:
Current HIV/AIDS Reports
|
Ausgabe 3/2019
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Abstract
Purpose of Review
End-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 Findings
HIV+ 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.
Summary
SOT 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.