Infections in solid organ transplant HIV-infected patients

• Published in: Clinical microbiology and infection Vol. 20; no. s7; pp. 119 - 130
• Main Authors: Miro, J.M, Agüero, F., Duclos-Vallée, J.-C., Mueller, N.J, Grossi, P., Moreno, A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2014; Elsevier Limited
• Subjects: End-stage organ disease; Europe; hepatitis B virus; hepatitis C virus; highly active antiretroviral therapy; HIV/AIDS; Humans; Immunocompromised Host; Immunosuppressive Agents - therapeutic use; Incidence; Infection Control - methods; infections; North America; Opportunistic Infections - diagnosis; Opportunistic Infections - epidemiology; Opportunistic Infections - prevention & control; Opportunistic Infections - therapy; Organ Transplantation; prophylaxis of opportunistic infections; solid organ transplantation; Transplant Recipients; North America; Europe; HIV/AIDS; hepatitis B virus; highly active antiretroviral therapy; hepatitis C virus; infections; solid organ transplantation; End-stage organ disease; prophylaxis of opportunistic infections
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/1469-0691.12754

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.