Abstract
Kidney allograft survival in HIV-infected patients is lower than in the general population. Belatacept increases long-term patients and allografts survival compare to anticalcineurins (CNI). Its use in HIV-positive recipients is poorly documented. We retrospectively reported a French cohort of HIV-positive kidney allograft recipients treated with belatacept. Patient and allograft survivals, HIV immunovirological and clinical evolution, acute rejection, opportunistic infections (OI), and donor-specific anti-HLA antibodies (DSA) were analyzed and compared to an historical CNI control group. Fourteen patients were treated with belatacept: 2 (16%) de novo and 12 (84%) switches 10 [2-30] months after transplantation. One year after belatacept therapy patients’ and allografts survival were 91% and 92% respectively with two (17%) HIV viral rebound linked to antiretroviral therapy non-compliance while CD4+ and CD8+ T cell count remained over time. Serious adverse events included 2 (17%) acute steroid-resistant T-cell mediated rejections and 2 (17%) OI. Kidney allograft function increased significantly 12-months after switch (P=0.009) whereas proteinuria remained comparable. DSAs remained stable 12 months after treatment. Results were similar in control group. Belatacept can be used safely and could increase long-term kidney allograft survival in HIV+ kidney allograft recipients. These results need to be confirmed in a larger cohort.
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