Need for Kidney Transplantation in HIV-positive Individuals: Results of a Survey in Italy

• Published in: Scandinavian journal of infectious diseases 2004-01, Vol.36 (9), p.600-604
• Main Authors: Tumietto, Fabio, Costigliola, Paolo, Zagnoli, Alessandra, Nafissi, Michele, Farneti, Barbara, Chiodo For Project Host, Francesco
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Comorbidity; Female; Health Care Surveys; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Seropositivity; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Italy - epidemiology; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - surgery; Kidney Transplantation - standards; Kidney Transplantation - trends; Male; Medical sciences; Middle Aged; Needs Assessment; Patient Selection; Prognosis; Risk Assessment; Severity of Illness Index; Survival Analysis; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0036-5548; 1651-1980
• DOI: 10.1080/00365540410020820

It is well known that HIV+individuals can be affected by end-stage renal diseases (ESRD). Despite the availability of new effective antiretroviral therapies, HIV-infected people are generally excluded from kidney transplantation, the treatment of choice for ESRD. A small number of transplantations have been performed, with encouraging data in terms of graft and patient survival. To evaluate the need of kidney transplant for HIV+individuals, we designed a multicentre study which enabled the simulation of a virtual transplant waiting list for those on dialytic treatment. In 38 participating infectious disease units, 16 HIV+patients were selected for renal replacement treatment/dialytic treatment, and they were enrolled. Clinical data were collected in order to apply general exclusion criteria and evaluate HIV clinical status. Clinical data confirmed inclusion of 7/16 patients. After application of CD4+count and HIV viraemia for further selection, the number of subjects was significantly reduced. Six patients had CD4+count greater than 200/cmm (2/6 with undetectable HIV viraemia). Only 3 patients had CD4+higher than 350/cmm (1/3 with undetectable HIV viraemia). Our data represent the first evaluation of the need and eligibility for kidney transplantation for HIV+subjects with ESRD. Application of HIV infection related parameters as selection criteria has a great strength in reducing the waiting list of HIV+subjects suitable for kidney transplant and could be carefully considered when planning inclusion/exclusion criteria for experimental purposes.