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McMullen L, Drak D, Basu G, Coates PT, Goodman DJ, Graver A, Isbel N, Lim WH, Luxton G, Sciberras F, Toussaint ND, Wong G, Gracey DM. Kidney transplantation in people living with human immunodeficiency virus: An overview of the Australian experience. Nephrology (Carlton) 2024; 29:34-38. [PMID: 37605476 DOI: 10.1111/nep.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
Kidney transplantation in people living with HIV (PLWHIV) is occurring with increasing frequency. Limited international data suggest comparable patient and graft survival in kidney transplant recipients with and without HIV. All PLWHIV aged ≥18 years who received a kidney transplant between 2000 and 2020 were identified by retrospective data initially extracted from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), with additional HIV-specific clinical data extracted from linked local health-care records. Twenty-five PLWHIV and kidney failure received their first kidney transplant in Australia between January 2000 and December 2020. Majority were male (85%), with median age 54 years (interquartile range, IQR 43-57). Focal segmental glomerulosclerosis was the most common primary kidney disease (20%), followed by polycystic kidney disease (16%). 80% of patients underwent induction with basiliximab and none with anti-thymocyte globulin (ATG). Participants were followed for median time of 3.5 years (IQR 2.0-6.5). Acute rejection occurred in 24% of patients. Two patients lost their allografts and three died. Virological escape occurred in 28% of patients, with a maximum viral load of 190 copies/mL. In conclusion, kidney transplantation in PLWHIV in Australia is occurring with increasing frequency. Acute rejection is more common than in Australia's general transplant population, but this does not appear to be associated with higher rates of graft failure or mortality out to four years.
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Affiliation(s)
- Lucy McMullen
- Renal Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Douglas Drak
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Gopal Basu
- Renal Medicine Unit, The Alfred, Melbourne, Victoria, Australia
- Monash University (Central Clinical School), Melbourne, Victoria, Australia
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - David J Goodman
- Department of Nephrology, St Vincent's Hospital, Fitzroy, Australia
| | - Alison Graver
- Kidney Transplant Service, Department of Nephrology, Austin Health, Heidelberg, Australia
| | - Nicole Isbel
- Department of Kidney Medicine, Princess Alexandra Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Grant Luxton
- Department of Nephrology, Prince of Wales Hospital, Sydney, Australia
| | - Frederika Sciberras
- Western Renal Services, Western Sydney Local Health District, Sydney, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Victoria, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - David M Gracey
- Renal Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
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Rivera FB, Ansay MFM, Golbin JM, Alfonso PGI, Mangubat GFE, Menghrajani RHS, Placino S, Taliño MKV, De Luna DV, Cabrera N, Trinidad CN, Kazory A. HIV-Associated Nephropathy in 2022. GLOMERULAR DISEASES 2022; 3:1-11. [PMID: 36816427 PMCID: PMC9936764 DOI: 10.1159/000526868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/22/2022] [Indexed: 02/24/2023]
Abstract
Background HIV-associated nephropathy (HIVAN) is a renal parenchymal disease that occurs exclusively in people living with HIV. It is a serious kidney condition that may possibly lead to end-stage kidney disease, particularly in the HIV-1 seropositive patients. Summary The African-American population has increased susceptibility to this comorbidity due to a strong association found in the APOL1 gene, specifically two missense mutations in the G1 allele and a frameshift deletion in the G2 allele, although a "second-hit" event is postulated to have a role in the development of HIVAN. HIVAN presents with proteinuria, particularly in the nephrotic range, as with other kidney diseases. The diagnosis requires biopsy and typically presents with collapsing subtype focal segmental glomerulosclerosis and microcyst formation in the tubulointerstitial region. Gaps still exist in the definitive treatment of HIVAN - concurrent use of antiretroviral therapy and adjunctive management with like renal-angiotensin-aldosterone system inhibitors, steroids, or renal replacement therapy showed benefits. Key Message This study reviews the current understanding of HIVAN including its epidemiology, mechanism of disease, related genetic factors, clinical profile, and pathophysiologic effects of management options for patients.
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Affiliation(s)
- Frederick Berro Rivera
- Department of Medicine, Lincoln Medical Center, New York, New York, USA,*Frederick Berro Rivera,
| | | | | | | | | | | | - Siena Placino
- St. Luke's Medical Center College of Medicine - William H. Quasha Memorial, Quezon City, Philippines
| | | | | | - Nicolo Cabrera
- Division of Infectious Diseases, George Washington University, Washington, District of Columbia, USA
| | - Carlo Nemesio Trinidad
- Section of Nephrology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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