Infectious complications in HIV-infected kidney transplant recipients

Int J STD AIDS. 2018 Mar;29(4):341-349. doi: 10.1177/0956462417726213. Epub 2017 Sep 1.

Abstract

Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58-1.39; p = 0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p = 0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival.

Keywords: HIV infection; Kidney transplant; highly active antiretroviral therapy; post-transplant infections.

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Case-Control Studies
  • Female
  • Graft Rejection
  • Graft Survival
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Immunosuppression Therapy / methods*
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Renal Insufficiency / surgery*
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Immunosuppressive Agents