Human immunodeficiency virus and renal transplantation

CASE PRESENTATIONA 48-year-old African-American man with chronic human immunodeficiency virus (HIV) infection since 1987 was referred to our center for renal transplant evaluation. HIV-associated nephropathy had been diagnosed 8 years earlier by renal biopsy. Hemodialysis had been initiated 3 years earlier. Past medical history was significant for hypertension and hyperlipidemia. Before transplantation, total cholesterol was 178 mg per 100 ml, low-density lipoprotein was 40 mg per 100 ml, and high-density lipoprotein was 67 mg per 100 ml without lipid-lowering therapy. The patient reported no history of earlier opportunistic infection (OI), malignancy, or co-infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). He had been treated with highly active antiretroviral therapy (HAART) since 1990. After numerous treatment failures, virologic suppression was finally achieved with a combination of lamivudine, abacavir, efavirenz, and lopinavir/ritonavir.