Outcomes after kidney transplantation were worse among patients coinfected with HIV and hepatitis C virus when compared with those without either infection or HIV alone, according to recent data.

“Kidney transplantation is now offered as an acceptable treatment option for HIV-positive end-stage renal disease patients and has expanded beyond the scope of clinical trials,” the researchers wrote. “Although this marks a new era in the care of the HIV-positive ESRD patient, experience with HIV-positive kidney transplantation remains in its relative infancy.

“Concerns remain regarding the high incidence of acute rejection after HIV-positive kidney transplantation and its possible effect on long-term transplant outcomes.”

Using data recorded in the Scientific Registry of Transplant Recipients from 2002 to 2011, researchers analyzed graft and long-term survival data from 510 adult kidney transplant recipients with HIV and 94,948 recipients without HIV. On average, recipients with HIV were younger, less likely to be obese, and more often male and black, compared with recipients without HIV. Kidney recipients with HIV also were more likely to have HCV infection (24.2% vs. 5.5%; P<.001).

Graft survival at 5 and 10 years was lower among the HIV cohort when compared with patients without HIV (HR = 1.37; 95% CI, 1.15-1.64); however, no difference was seen when comparing HIV monoinfected recipients to those without HIV and HCV (HR = 1.06; 95% CI, 1.85-1.33). Worse graft survival was reported among HIV/HCV coinfected recipients vs. those with HCV alone (HR = 1.38; 95% CI, 1.08-1.77). These trends persisted when controlling for death.

Similar results were observed among patient survival rates. Recipients with HIV were less likely to survive when compared with recipients without HIV (HR = 1.34; 95% CI, 1.08-1.68), but not when either group was infected with HCV (HR = 1.26; 95% CI, 0.98-1.69). Decreased patient survival was observed among coinfected recipients compared with controls with HCV only (HR =1.57; 95% CI, 1.11-2.23).

“These results are encouraging, but they do suggest caution in transplanting HIV-positive recipients coinfected with HCV, motivating future studies of survival benefit,” the researchers wrote. — by Dave Muoio

...