Abstract
Southern African HIV Clinicians Society guidelines for solid organ transplantation in human immunodeficiency virus: An evidence-based framework for human immunodeficiency virus-positive donors and recipients.
Highlights
These guidelines, intended for transplantation healthcare practitioners in Southern Africa, seek to sketch an evidence-based framework for human immunodeficiency virus (HIV)-positive donors and recipients regarding solid organ transplantation
Human immunodeficiency virus-positive patients demonstrate a faster decline in renal function than HIV-negative patients, and an approximately threefold increased risk of end-stage renal disease.[3,4,5]
People living with HIV have a higher risk of acute and chronic liver failure, accelerated progression of hepatitis B and C co-infection to cirrhosis, and an increased risk of hepatocellular carcinoma compared with HIV-negative controls.[6,7,8]
Summary
These guidelines, intended for transplantation healthcare practitioners in Southern Africa, seek to sketch an evidence-based framework for human immunodeficiency virus (HIV)-positive donors and recipients regarding solid organ transplantation. In the case of HIV-positive recipients of liver transplants, there is evidence that using a CD4+ threshold ≥ 100 cells/μL is safe provided there is no history of any opportunistic infection or malignancy (in which case a CD4+ threshold of 200 cells/μL is recommended).[41] Another exception to the rule would be immune non-responders, who fail to reconstitute an adequate CD4+ count despite prolonged viral suppression, but this requires consultation with an infectious diseases specialist on a case-by-case basis. 4 T-cell percentage [CD4+%] ≥ 15% for patients aged < 5 years) Plasma VL < 50 copies/μL The recipient must be able to receive a safe and effective ART regimen, considering the donor’s anticipated HIV viral resistance strains. HIV-positive transplant recipients should receive the same post-transplantation prophylaxis for opportunistic infections as HIV-negative transplant recipients
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