Infections in solid organ transplant HIV-infected patients

Abstract

Solid organ transplantation (SOT) is an appropriate therapeutic option for HIV-infected patients with end-stage organ disease. Recent experience in North America and Europe indicates that 3- to 5-year survival in HIV/HCV-coinfected liver recipients is lower than that of HCV-monoinfected recipients. Conversely, 3- to 5-year survival of non-HCV-coinfected transplant patients (liver, kidney and heart) was similar to that of non-HIV-infected patients. Preliminary experience with lung transplantation and combined kidney and pancreas transplantation is also satisfactory. Infections in HIV-infected recipients during the post-transplant period are similar to those seen in non-HIV-infected patients, although the incidence rates of tuberculosis and fungal infections seem to be higher. HIV-infected patients who are being evaluated for SOT should follow the same recommendations as those used for non-HIV-infected patients in order to prevent infections during the pre-transplant period. After transplantation, HIV-infected SOT recipients must follow recommendations on post-SOT and anti-HIV immunization and on antimicrobial prophylaxis. The recommended antiretroviral regimen is one based on raltegravir or dolutegravir plus two nucleos(t)ide reverse transcriptase inhibitors (tenofovir + emtricitabine or abacavir + lamivudine), because it can prevent pharmacokinetic interactions between antiretroviral drugs, immunosuppressive drugs and some of the antimicrobial agents used to treat or prevent post-transplant infections. In this manuscript, we review current recommendations for preventing infections both before and after transplantation. We also analyse the incidence, aetiology and clinical characteristics of opportunistic and non-opportunistic bacterial, mycobacterial, fungal and viral infections in HIV-infected SOT recipients during the post-transplant period.

Human immunodeficiency virus infection does not worsen prognosis of liver transplantation for hepatocellular carcinoma

“…HIV‐infected recipients received the same immunosuppressive regimens as non‐HIV‐infected patients according to local protocols. Post‐LT and HIV infection antimicrobial prophylaxis was administered according to national guidelines . Thirteen of the 19 (68%) participating centers had a specific protocol for surveillance of HCC recurrence, which consisted of periodic (3‐6 months) imaging techniques and alpha‐fetoprotein measurements for at least the first 3 years after LT .…”

“…Post-LT and HIV infection antimicrobial prophylaxis was administered according to national guidelines. 18,19 Thirteen of the 19 (68%) participating centers had a specific protocol for surveillance of HCC recurrence, which consisted of periodic (3-6 months) imaging techniques and alpha-fetoprotein measurements for at least the first 3 years after LT. 15 LT teams from the remaining six centers did not follow any surveillance protocol. 15 Statistical Analysis.…”

An Update on Heart Transplantation in Human Immunodeficiency Virus–Infected Patients

“…vaccination) are recommended (39,40). Of note, the ideal duration of posttransplant PCP prophylaxis is unknown.…”

Cobicistat Significantly Increases Tacrolimus Serum Concentrations in a Renal Transplant Recipient with Human Immunodeficiency Virus Infection

“…The decreased mortality from acquired immune deficiency syndrome–defining illnesses has been associated with increased prevalence of chronic illnesses (e.g., end‐stage renal or liver disease) for which solid organ transplantation may be a therapeutic option. HIV infection is not an absolute contraindication to renal transplantation; however, pharmacologic management in this patient population presents a distinctive challenge given the propensity for drug‐drug interactions and overlapping toxicities between HAART and immunosuppressants …”

“…Ó 2016 Pharmacotherapy Publications, Inc. C A S E R E P O R T S management in this patient population presents a distinctive challenge given the propensity for drug-drug interactions and overlapping toxicities between HAART and immunosuppressants. 1,2 Cobicistat is a novel pharmacokinetic booster designed as an inhibitor of cytochrome P450 (CYP) 3A with no intrinsic activity against HIV. It was first approved by the U.S. Food and Drug Administration in 2012 as a component in the fixed-dose combination product Stribild (Gilead Sciences, Inc., Foster City, CA), which also contains elvitegravir, emtricitabine, and tenofovir disoproxil fumarate.…”