When is kidney transplantation indicated for the treatment of HIV-associated nephropathy (HIVAN)?

Updated: May 09, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Answer

Immunosuppression after kidney transplantation is thought to pose a substantive risk of opportunistic infections in patients with HIVAN. [22] Consequently, kidney transplantation in these patients is performed with caution in compliant, stable patients with no prior opportunistic infections who have an undetectable viral load and a CD4+ T-cell count of more than 300 cells/µL. However, anecdotal reports drawn from small samples of selected patients with HIVAN suggest no extra risk of opportunistic infections. Until larger studies are performed, transplantation in persons with HIVAN should be focused on stable patients. [23]

Given the strong association between the APOL1 risk variants and HIVAN, HIV-positive recipients of African descent and those who receive an allograft from a donor of African descent should be monitored for recurrent HIVAN. The relative contribution of donor and recipient APOL1 risk status to the risk of HIVAN recurrence is the subject of ongoing research. [4]   


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