The prevalence of human immunodeficience virus (
HIV) infection among patients under
renal replacement therapy varies, with estimates of 1% for Europe and 1.5% for the United States. Survival in HIV infected individuals receiving
renal replacement therapy has improved since the introduction of high activity antiretroviral
therapy (
HAART). Current experience in
renal transplantation in HIV-infected patients in the United States indicates that the three-year survival rate is similar to that of HIV-negative transplant recipients, with virological and immunological control of the
infection by
HAART and no increase in the number of
opportunistic infections or
tumors. The criteria for selecting
renal transplantation candidates in this population are the following: no
aids-defining events, CD4 cells > 200 cells/.l and undetectable viral load under
HAART. In Spain, where most of these patients are former drug abusers, a two-year period of abstinence from
cocaine and heroine abuse is also required, although patients can be participating in the
methadone program. The main problems in the post-
transplantation period have been interactions between
HAART and immunosuppressive drugs, management of hepatitis C virus (HCV)
coinfection and the high rate of acute rejection. To date, seven such
renal transplantations have been performed in Spain, with favorable patient and graft survival and no progression to
aids.