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Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review. Transplant Direct 2023; 9:e1441. [PMID: 36733439 PMCID: PMC9886517 DOI: 10.1097/txd.0000000000001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 01/28/2023] Open
Abstract
The pharmacotherapeutic management of people living with HIV (PLWHIV) undergoing solid organ transplantation (SOT) is clinically challenging, mainly due to the frequent occurrence of complex drug-drug interactions. Although various strategies have been proposed to improve treatment outcomes in these patients, several uncertainties remain, and consensus practice guidelines are just beginning to emerge. The main objective of this scoping review was to map the extent of the literature on the pharmacotherapeutic interventions performed by healthcare professionals for PLWHIV undergoing SOT. Methods We searched Medline, Embase, and the Cochrane databases as well as gray literature for articles published between January 2010 and February 2020. Study selection was performed by at least 2 independent reviewers. Articles describing pharmacotherapeutic interventions in PLWHIV considered for or undergoing SOT were included in the study. Results Of the 12 599 references identified through our search strategy, 209 articles met the inclusion criteria. Results showed that the vast majority of reported pharmacotherapeutic interventions concerned the management of immunosuppressive and antimicrobial therapy, including antiretrovirals. Analysis of the data demonstrated that for several aspects of the pharmacotherapeutic management of PLWHIV undergoing SOT, there were differing practices, such as the choice of immunosuppressive induction and maintenance therapy. Other important aspects of patient management, such as patient counseling, were rarely reported. Conclusions Our results constitute an extensive overview of current practices in the pharmacotherapeutic management of SOT in PLWHIV and identify knowledge gaps that should be addressed to help improve patient care in this specific population.
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Gilbert J, Manji A. Considerations in the Management of a Kidney Transplant Patient With HIV. Cureus 2021; 13:e18744. [PMID: 34659933 PMCID: PMC8513352 DOI: 10.7759/cureus.18744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
In the wake of highly active antiretroviral therapy (HAART), kidney transplantation has become common practice in HIV-positive recipients. However, management is more complex than that of a seronegative recipient in the pre-operative, peri-operative, and post-operative periods. Although the standard HAART regimen is often modified to improve outcomes and reduce interactions with the post-transplant immunosuppressive regimen, kidney transplantation in HIV-positive individuals is feasible, with high graft survival rates comparable to those in their seronegative counterparts. There is also increasing interest in the possibility of HIV-positive kidney donation, which could increase the donor pool in seropositive patients with end-stage renal disease. This report highlights considerations in the management of a seropositive kidney recipient, reviewing the evidence that underpins current treatment guidelines and highlighting the role of HAART in the dramatic change in attitude towards transplantation in this population. It also addresses studies from multiple countries which have shown favourable outcomes in transplants from HIV-positive donors. This warrants further investigation into seropositive-to-seropositive transplantation as a potential therapeutic option.
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Affiliation(s)
- James Gilbert
- Surgery, Christ Church, University of Oxford, Oxford, GBR
| | - Ali Manji
- Medical Sciences, University of Oxford, Oxford, GBR
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Hwang HP, Yu HC, Kang KP, Kim W, Park SK, Ku JS, Kim H, Lee S. Kidney transplantation in human immunodeficiency virus-infected patients: a report of two cases and a review of the literatures. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:60-64. [PMID: 35769407 PMCID: PMC9186908 DOI: 10.4285/jkstn.2019.33.3.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/04/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection was traditionally considered an absolute contraindication for transplantation because of concerns about HIV disease progression due to immunosuppression. Since potent antiretroviral therapies (ARTs) have become widely available, the prognosis of HIV-infected kidney transplant recipients has dramatically improved. Recent results of prospective multicenter trials on kidney transplantation (KT) in HIV-positive candidates have demonstrated the success and challenges of transplantation in this population. Several studies have reported comparable patient and graft outcomes between HIV-infected and HIV-uninfected recipients after KT in the era of potent combined ARTs. We report two cases of HIV-infected patients who underwent KT at our hospital. In this paper, we present a detailed report of two cases and provide a short review of the existing literature.
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Affiliation(s)
- Hong Pil Hwang
- Department of General Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of General Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Won Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Sung Kwang Park
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Jeong Sang Ku
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Hyeongwan Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Sik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
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Sawinski D. Kidney transplantation for HIV-positive patients. Transplant Rev (Orlando) 2016; 31:42-46. [PMID: 27776929 DOI: 10.1016/j.trre.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/24/2016] [Accepted: 10/05/2016] [Indexed: 12/22/2022]
Abstract
HIV+ patients are at increased risk for end-stage renal disease, but HIV infection was once considered a contraindication to renal transplantation. However, contemporary studies from the United States and Europe have now demonstrated that renal transplantation is a safe and effective treatment for end-stage renal disease in HIV patients, with equivalent patient and allograft survival to those uninfected. Broader experience in transplantation in HIV+ patients has identified unique challenges including high rates of acute rejection, delayed graft function, and significant drug-drug interactions. Kidney transplantation in HIV-infected patients is an active area of clinical research and trials of HIV+ to HIV+ transplantation in the United States are underway.
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Affiliation(s)
- Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104.
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5
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Vicari AR, Spuldaro F, Sandes-Freitas TV, Cristelli MP, Requião-Moura LR, Reusing JO, Pierrotti LC, Oliveira ML, Girão CM, Gadonski G, Kroth LV, Deboni LM, Ferreira GF, Tedesco-Silva H, Esmeraldo R, David-Neto E, Saitovitch D, Keitel E, Garcia VD, Pacheco-Silva A, Medina-Pestana JO, Manfro RC. Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience. Transpl Infect Dis 2016; 18:730-740. [PMID: 27503081 DOI: 10.1111/tid.12592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/27/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. METHODS HIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. RESULTS Fifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. CONCLUSIONS In the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
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Affiliation(s)
- A R Vicari
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F Spuldaro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - M P Cristelli
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - L R Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - J O Reusing
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - L C Pierrotti
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - M L Oliveira
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - C M Girão
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - G Gadonski
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L V Kroth
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L M Deboni
- Hospital Municipal São José e Fundação Pró-Rim, Joinville, SC, Brazil
| | - G F Ferreira
- Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - H Tedesco-Silva
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - R Esmeraldo
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - E David-Neto
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - D Saitovitch
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - E Keitel
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - V D Garcia
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - A Pacheco-Silva
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - R C Manfro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Shroff RC, McCulloch M, Novelli V, Shingadia D, Bradley S, Clapson M, Mamode N, Marks SD. Successful outcome of renal transplantation in a child with HIV-associated nephropathy. Arch Dis Child 2014; 99:1026-8. [PMID: 25123405 DOI: 10.1136/archdischild-2013-305395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Classical HIV-associated nephropathy (HIVAN) was first described before the advent of highly active antiretroviral therapy in late stages of HIV disease with high viral load and low CD4 cell count. Renal transplantation has been successful in a large series of carefully selected HIV-infected adults, with patient and renal allograft survival approaching those of non-HIV-infected patients. We report the successful outcome of living related renal transplantation in a vertically transmitted HIV-infected 8-year-old girl with end-stage kidney disease on haemodialysis due to HIVAN. The pretransplant preparations and post-transplant care, with particular emphasis on immunosuppression and avoidance of opportunistic infections, are discussed.
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Affiliation(s)
- Rukshana C Shroff
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mignon McCulloch
- Department of Paediatric Nephrology, Evelina Children's Hospital, London, UK
| | - Vas Novelli
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - Delane Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - Suzanne Bradley
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Margaret Clapson
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - Nizam Mamode
- Department of Renal Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Stosor V. Organ Transplantation in HIV Patients: Current Status and New Directions. Curr Infect Dis Rep 2013; 15:526-35. [PMID: 24142801 DOI: 10.1007/s11908-013-0381-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Combination antiretroviral therapy has resulted in longer life expectancies in persons living with HIV; however, end organ disease and death from organ failure have become growing issues for this population. With effective therapies for viral suppression, HIV is no longer considered an absolute contraindication to organ transplantation. Over the past decade, studies of transplantation in patients with HIV have had encouraging results such that patients with organ failure are pursuing transplantation. This review focuses on the current status of organ transplantation for HIV-infected persons.
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Affiliation(s)
- Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL, 60611, USA,
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Gathogo EN, Hamzah L, Hilton R, Marshall N, Ashley C, Harber M, Levy JB, Jones R, Boffito M, Khoo SH, Drage M, Bhagani S, Post FA. Kidney transplantation in HIV-positive adults: the UK experience. Int J STD AIDS 2013; 25:57-66. [PMID: 23970634 DOI: 10.1177/0956462413493266] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.
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