Kidney transplantation in HIV infected patients *

This review article aims at presenting the main considerations on kidney transplantation in HIV-positive patients. Over last decade, after the advent of highly active antiretroviral therapy (HAART), life expectancy in patients infected with the human immunodeficiency virus (HIV) has changed significantly, with a marked decrease in morbidity and mortality rates in this population. In this setting, the numbers of HIV-positive patients with end-stage kidney disease requiring dialysis is progressively increasing. In view of this new reality, kidney transplantation, once absolutely contraindicated in such patients, became an alternative as renal replacement therapy. Issues about the use of immunosuppressive agents in this group of patients and their potential action in increasing HIV replication, besides the risk of opportunistic infections and neoplasm development, are widely discussed. However, clinical experience in this field shows that using these drugs in seropositive patients seems to be safe, even with reports of antiretroviral action of some immunosuppressant drugs. Nevertheless, there are few transplantation reports in this population. In summary, literature data suggests that kidney transplantation, following specific selection criteria, seems to be a safe alternative as kidney replacement therapy in this group.