Since 1995, the life expectancy of HIV+ patients has dramatically improved because of the introduction of the Highly Active Anti-Retroviral Therapy (HAART). In fact, the AIDS mortality rate has diminished consistently and currently HIV+ patient life expectancy is >30 years from the time of diagnosis. However, the incidence of kidney and liver complications, particularly those related to the hepatitis C virus, rose significantly among HIV+ patients. It has been proven that the HIV infection accelerates the course of these complications, which then evolve more rapidly than in HIV negative patients. Considering the mortality projection, the mortality related to the hepatitis C virus rose from 3,800-4,200 in 1998 to an expected 14,000-19,000 in 2030. Observed HIV-related mortality was 16,000 in 1998 and projected to be 4,200-6,700 for 2030. Transplantation might often be the only treatment option available to patients co-infected by the HIV and hepatitis C virus.

A number of scientific papers and a (limited) clinical experience support the enrollment of HIV+ patients on transplant waiting lists. From a practical point of view, some pharmacological precautions are needed in the management of HIV+ patients after transplantation, particularly to prevent toxicity from the combined use of immunosuppressive drugs and anti-retroviral drugs. Apart from these precautions, the pre- and post-operative course for HIV+ patients does not differ from that of HIV negative patients undergoing organ transplantation. Nevertheless, for different reasons (clinical, ethical, etc.) at the present time only a small number of US transplant centers are willing to wait-list HIV+ patients and perform organ transplants on them.

In the Division of Transplantation at Jefferson we believe that it is crucial to learn and understand the most common causes of resistance by physicians who do not consider HIV+ patients as suitable recipients for organ transplantation, as well as to document the current status of outcomes among the centers that do perform organ transplantation on HIV+ patients.

Since January 2003 Dr. Ignazio Marino’s staff at Jefferson’s Division of Transplantation Surgery has been working on the creation of the 1st electronic International Registry for HIV+ Transplant Patients with the specific aims to:

• gather clinically relevant data on HIV+ transplant recipients
• document transplant outcomes and provide ultimate scientific evidence that there are no contraindications for organ transplantation on HIV+ patients
• create an official, unique and incontrovertible document constituting a point of reference for anyone interested in HIV and transplantation

Contact us: mail@hivtransplant.org