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Start medication with one kidney, if so which ones
Aug 20, 2005

My background: I just got diagnosed as being HIV+ on June 14, 2005. Second test confirmed it a week later, with viral load of 5840 and CD4 count of 346. I also donated 1 of my kidneys to my older sister in Dec 2003. Prior to June 2005, I tested HIV- on Dec 2004.

My questions are: 1. what are the chances that my sister would be HIV+ from my kidney donation in Dec 2003 if I tested HIV- in Dec 2004?

2. Given that I only have 1 kidney now and I'm taking high blood pressure medication (atacand) to deal with it, would it be wise for me to start HIV medications right away or should I hold off? My concern is that taking HIV medication might be too harsh on my remaining kidney, esp. if I'll be taking them for a longer period of time.

3. If I start HIV medications right away, which ones should I stay away from in terms of impacts to kidneys, etc? Also, which ones would you recommend if I'm concerned about lipodystrophy and/or lipoapathy?

Response from Dr. Pierone

Since you were not infected with HIV when you donated the kidney, your sister is not at risk. Donating a kidney is a very considerate and caring act; I hope that your sister is doing well with your donated kidney.

Since you have a recent infection and a low viral load you should be able to wait before starting HIV medications. It generally takes a few lab reports several months apart before one gets a true sense of the CD4 count and viral load trend.

When you do start therapy it would make sense to avoid Viread (or Truvada) because of occasional cases of kidney toxicity. Zerit and AZT are most associated with lipoatrophy, so Epzicom + Sustiva might be the best choice. Best of luck to you and let us know how things go.



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