HIV 感染者的实体器官移植：历史、进展与前沿。
Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers.
机构信息
Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street/PCTB Room 228, Baltimore, MD, 21205, USA.
Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Curr HIV/AIDS Rep. 2019 Jun;16(3):191-203. doi: 10.1007/s11904-019-00440-x.
PURPOSE OF REVIEW
End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers.
RECENT FINDINGS
HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
目的综述
在感染艾滋病毒（HIV）的个体中，终末期器官疾病的患病率正在增加。试验和登记数据证实，实体器官移植（SOT）在该人群中是有效的。优化移植的机会并减少并发症是当前的前沿领域。
最近的发现
HIV 阳性受者既往经历 2-4 倍更高的排斥反应。整合酶链转移抑制剂（INSTIs）可最大程度减少药物相互作用，并可能通过淋巴细胞耗竭诱导免疫抑制来降低排斥反应。丙型肝炎病毒（HCV）合并感染与预后不良相关，但直接作用抗病毒药物（DAA）可能减轻这种情况。南非和美国艾滋病毒器官政策公平（HOPE）法案的经验支持 HIV 阳性供体向 HIV 阳性受者（HIV D+/R+）移植。SOT 是 HIV 阳性个体终末期器官疾病的最佳治疗方法。最近的进展包括在移植受者中使用 INSTIs 和 DAA；然而，需要制定策略来增加移植机会。正在研究 HIV D+/R+移植，这可能会增加移植机会，并为 HIV 治愈和发病机制研究提供见解。
Zotero 插件