Transplantation for Patients Infected with Human Immunodeficiency Virus: No Longer Experimental but Not Yet Routine

Impact of Human Immunodeficiency Virus on Survival After Liver Transplantation: Analysis of United Network for Organ Sharing Database

“…Shorter survival rates of HIV(ϩ) patients may be related to several factors, including drug interactions between HAART and immunosuppressive drugs or between HAART and HCV treatment, delayed referrals of HIV(ϩ) patients for LT evaluation leading to late transplants, and more rapid progression of hepatic fibrosis in HIV-coinfected patients compared with HCV patients without coinfection (20,22,23). The recommended initial HAART regimen is generally a combination of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) plus a protease inhibitor, two NRTIs plus a non-NRTI, or three NRTIs (29).…”

“…Although most of the NRTIs do not interact with immunosuppressive medications, non-NRTIs, and specifically protease inhibitors, are known to cause significant drug interactions by either inhibiting (e.g., lopinavir/ritonavir combination, delavirdine) or inducing cytochrome P450 3A4 (e.g., nevirapine, efavirenz) (30,31). Recurrent HCV progresses more rapidly to cirrhosis in HIV/HCV-coinfected patients (22). HCV itself might constitute a risk for HAART-induced hepatotoxicity precluding safe administration of HAART on HIV/HCV-coinfected patients (32).…”

Renal transplantation in an HIV-infected patient: Pharmacokinetic aspects

“…It has been demonstrated that protease inhibitors used as a component of HAART inhibit cytochrome P-450 and may cause markedly elevated levels of calcineurin inhibitors, while the non-nucleoside reverse transcriptase inhibitors induce this enzyme system, leading to a rapid elimination of calcineurin inhibitors [8,9]. Hence, drug-drug interactions in this case are complex.…”

Liver transplantation in HIV-positive patients: the position of the Brazilian groups

“…However, it is recommended that the issue must be widely discussed by a multidisciplinary team (hepatologists, surgeons, pathologists, virologists, infectologists, immunologists, etc. (29) ), and centers which do not have these resources should no take care of HIVinfected transplant recipients (9) . Another aspect to be discussed by the professionals involved is the risk of needle stick injury, which are more frequent in surgeries of long duration and often performed at night or early morning, as is common in transplants (remember that the risk is present after the procedure).…”