1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
2Fundeni Clinical Institute, Department of Kidney Transplantation, Bucharest, Romania.
Rom J Intern Med. 2024 Jun 7;62(3):362-368. doi: 10.2478/rjim-2024-0020. Print 2024 Sep 1.
Human immunodeficiency virus (HIV) is no longer considered a contraindication for kidney transplantation (KT). KT management in HIV patients is a complex process with challenges, such as drug interactions between immunosuppression and antiretroviral (ARV) therapy. In our country, no KT has been performed thus far in this category of patients.
We present the case of a 29-year-old female patient with HIV and end-stage renal disease (ESRD) who performed a KT from a related living donor in March 2022. KT immediate evolution was favorable. No transplant-related complications were reported. HIV viral load remained undetectable and CD4+ T cells were constantly > 500 cell/ μL, during the 18 months of follow-up. The main challenge in our case was the drug interaction between the protease inhibitor-based regimen and tacrolimus. This led to tacrolimus overdose, and, subsequently, change in ARV therapy. ARV switching was performed on a regimen based on integrase inhibitor and nucleoside reverse transcriptase inhibitors. After the ARV change, the therapeutic level of tacrolimus was easily reached and maintained. Kidney graft function remained normal during follow-up, despite tacrolimus overexposure, and no rejection or anti-HLA antibodies were observed. Another challenge was related to the donor's hepatitis C virus status (positive antibodies, negative nucleic acid test). The recipient did not develop seroconversion or detectable viremia at 3-, 6-, 12- and 18-months post-KT.
We reported the first case of a successful KT in an ESRD patient with HIV in Romania, in whom the post-transplant evolution was favorable.
人类免疫缺陷病毒（HIV）不再被认为是肾移植（KT）的禁忌症。HIV 患者的 KT 管理是一个复杂的过程，存在诸多挑战，如免疫抑制与抗逆转录病毒（ARV）治疗之间的药物相互作用。在我国，迄今为止尚未在这一类别患者中进行 KT。
我们报告了一例 29 岁女性 HIV 合并终末期肾病（ESRD）患者，于 2022 年 3 月接受相关活体供者的 KT。KT 即时转归良好。在 18 个月的随访中，未报告与移植相关的并发症。HIV 病毒载量持续不可检测，CD4+T 细胞持续＞500 个/μL。我们病例中的主要挑战是基于蛋白酶抑制剂的方案与他克莫司之间的药物相互作用。这导致他克莫司过量，随后改变了 ARV 治疗。ARV 转换为基于整合酶抑制剂和核苷逆转录酶抑制剂的方案。ARV 转换后，很容易达到并维持他克莫司的治疗水平。尽管他克莫司暴露过度，但在随访期间，肾移植物功能保持正常，未观察到排斥反应或抗 HLA 抗体。另一个挑战与供体丙型肝炎病毒状态（抗体阳性，核酸检测阴性）有关。在 KT 后 3、6、12 和 18 个月，受者未发生血清转换或可检测到病毒血症。
我们报告了罗马尼亚首例成功的 HIV 合并 ESRD 患者 KT 病例，其移植后转归良好。
