As mortality due to HIV/AIDS has declined with the development of effective treatment, there has been increasing focus on other causes of mortality among people living with HIV/AIDS, including renal and liver failure. Efforts have been underway to increase access to solid organ transplants, including liver and kidney transplants. As part of this work, a prospective study¹ has been underway reporting on the outcomes of HIV-infected people who have received a liver or kidney transplant, with follow-up data presented at the XVI International AIDS Conference by Roland and colleagues.

The study enrolled HIV-infected patients who had a CD4+ cell count greater than 200 cells/mm³, no history of selected opportunistic infections, and an undetectable viral load (with the exception of liver transplant candidates who were unable to tolerate antiretroviral therapy). The mean age of the transplant recipients (11 liver recipients, 18 kidney recipients) was about 45 years, with slightly over 50% of recipients identifying as white. Fifty-five percent of liver and 28% of kidney transplant recipients were positive for hepatitis C virus (HCV) coinfection.

They found very similar rates of patient and graft survival as has been described in HIV-uninfected patients. Despite relatively high rates of episodes of rejection, organ function remained very high. There was no HIV disease progression, and CD4+ cell counts remained stable in most patients, with lower levels seen in patients who were older, had episodes of rejection and used the immunosuppressant anti-thymocyte globulin (Thymoglobulin).

Of some concern was that two of the three deaths in the liver transplant group were due to recurrent HCV disease, while the third occurred in the setting of recurrence. The authors conclude that, to date, the study found that the risk and survival of transplant recipients were similar in HIV-infected and HIV-uninfected patients, although more work was needed on the management of HCV-coinfected patients following liver transplantation.

In another study presented at this conference, Tavio and colleagues² also highlighted some of the complexity of caring for HIV-infected transplant recipients. Their study looked at the pharmacokinetics of protease inhibitor use in six patients who underwent liver transplantation and were on immunosuppressive therapy. They described six patients on a nelfinavir (NFV, Viracept)-based regimen who underwent therapeutic drug monitoring, with three patients requiring a dose adjustment.

These encouraging data on the outcomes of organ transplantation are already of interest from a public health perspective, with the Ontario Advisory Committee on HIV/AIDS to collaborate with Roland and her team to explore improving access to organ transplantation for people living with HIV/AIDS in Ontario.³

Footnotes

1. Roland M, Barin B, Carlson L, et al. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. In: Program and abstracts of the XVI International AIDS Conference; August 13-18, 2006; Toronto, Canada. Abstract WEPE0052.

2. Tavio M, Baccarani U, Londero A, et al. Pharmacokinetic of protease inhibitors based regimens in 6 liver transplantation HIV-infected patients. In: Program and abstracts of the XVI International AIDS Conference; August 13-18, 2006; Toronto, Canada. Abstract CDB0332.

3. McGee F, English K, and the HIV and Organ Transplantation Working Group. HIV and organ transplantation: improving access in Ontario. In: Program and abstracts of the XVI International AIDS Conference; August 13-18, 2006; Toronto, Canada. Abstract WEPE0894.