Need for kidney transplantation in HIV-positive individuals: results of a survey in Italy.

Abstract

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.

• Authors: Fabio Tumietto, Paolo Costigliola, Alessandra Zagnoli, Michele Nafissi, Barbara Farneti, Francesco Chiodo, Project HOST
• Journal: Scandinavian journal of infectious diseases (Scand J Infect Dis) Vol. 36 Issue 9 Pg. 680-4 ( 2004) ISSN: 0036-5548 [Print] England
• PMID: 15370646 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Comorbidity
• Female
• HIV Infections (diagnosis, epidemiology)
• HIV Seropositivity
• Health Care Surveys
• Humans
• Italy (epidemiology)
• Kidney Failure, Chronic (diagnosis, epidemiology, surgery)
• Kidney Transplantation (standards, trends)
• Male
• Middle Aged
• Needs Assessment
• Patient Selection
• Prognosis
• Risk Assessment
• Severity of Illness Index
• Survival Analysis
• Treatment Outcome