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

  • HIV Pathogenesis and Treatment (AL Landay and NS Utay, Section Editors)
  • Published:
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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.

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Funding

This work was supported by the National Institute of Health T32 HL116275 to Dr. Werbel.

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  1. Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street/PCTB Room 228, Baltimore, MD, 21205, USA

    William A. Werbel & Christine M. Durand

  2. Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Christine M. Durand

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Werbel, W.A., Durand, C.M. Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers. Curr HIV/AIDS Rep 16, 191–203 (2019). https://doi.org/10.1007/s11904-019-00440-x

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