Department of Medicine, Center for Clinical Epidemiology and Biostatistics, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
Adv Chronic Kidney Dis. 2010 Jan;17(1):94-101. doi: 10.1053/j.ackd.2009.08.004.
HIV infection is a common cause of ESRD, particularly among blacks. Advances in antiretroviral therapy have greatly improved the survival of HIV patients, including those with renal disease. Despite concerns about the risk of immunosuppressive medications for HIV patients, emerging studies have now reported acceptable short-term outcomes for eligible HIV recipients undergoing renal transplantation, and an ongoing multicenter clinical trial reported 1-year patient and graft survival similar to that of HIV-uninfected kidney recipients. In these studies, the interactions between calcineurin inhibitors and HIV medications that are also metabolized by the cytochrome P450 system required substantial dosing modifications and careful monitoring of calcineurin inhibitor trough levels. These studies also revealed an elevated risk of acute rejection of the kidney allograft but few reports of opportunistic infections or viremia that could not be controlled. Long-term follow-up studies will be important to examine these outcomes and the development of malignancy to fully evaluate the risk and benefits of kidney transplantation among HIV-positive recipients.
HIV 感染是 ESRD 的常见病因，尤其是在黑人中。抗逆转录病毒治疗的进展极大地提高了 HIV 患者的生存率，包括那些患有肾脏疾病的患者。尽管人们对 HIV 患者使用免疫抑制药物的风险存在担忧，但新的研究现在已经报告了在适合接受肾移植的 HIV 患者中，短期结果可接受，一项正在进行的多中心临床试验报告了 1 年的患者和移植物存活率与未感染 HIV 的肾脏受者相似。在这些研究中，钙调磷酸酶抑制剂与 HIV 药物之间的相互作用（这些药物也通过细胞色素 P450 系统代谢）需要进行大量剂量调整，并需要仔细监测钙调磷酸酶抑制剂谷浓度。这些研究还揭示了肾移植后急性排斥反应的风险增加，但机会性感染或无法控制的病毒血症的报告很少。长期随访研究对于检查这些结果和恶性肿瘤的发展以充分评估 HIV 阳性受者接受肾移植的风险和益处非常重要。
