Oravec Torrance, Ready Erin, Hull Mark, Wright Alissa
Department of Medicine, University of British Columbia, Vancouver, British Columbia.
St Paul's Hospital Pharmacy, Providence Healthcare, Vancouver, British Columbia.
J Assoc Med Microbiol Infect Dis Can. 2024 Dec 19;9(4):249-273. doi: 10.3138/jammi-2024-0013. eCollection 2024 Dec.
A growing number of people living with HIV (PLWH) are developing an indication for hematopoietic stem cell transplantation (HSCT). While overlapping immunosuppression and medication interactions make this a complicated situation, the risk is mitigable, and PLWH should have similar access to HSCT as the general population. There are currently no guidelines available for the management of HSCT in PLWH, and through this document we hope to provide initial guidance.
We performed a non-systematic review of published English-language literature regarding medication and opportunistic infection risk management in both PLWH and HSCT recipients, as well as local, national, and international guidelines. We then generated recommendations for PLWH undergoing HSCT that went through multiple rounds of review with the authors and expert peers.
Patients living with well-controlled HIV are expected to have similar outcomes with HSCT as people without HIV. Focus should be on minimizing interruptions in antiretroviral therapy, avoiding drug-drug interactions (minimized with integrase strand transfer inhibitors), and managing overlapping toxicities. Opportunistic infections common in both advanced HIV and in HSCT include pneumonia, toxoplasmosis, herpes simplex virus, varicella zoster virus, and cytomegalovirus, with nontuberculous mycobacteria and cryptococcosis being somewhat more common in advanced HIV. Assuming a patient has well-controlled HIV, most of the opportunistic infection risk is due to transplant-related immunosuppression, and we provide specific prophylactic recommendations.
PLWH should have similar access to HSCT as people without HIV, and we offer this document as guidance to support hematology/oncology providers.
越来越多的人类免疫缺陷病毒感染者（PLWH）出现了造血干细胞移植（HSCT）的指征。虽然重叠的免疫抑制和药物相互作用使情况变得复杂，但风险是可以减轻的，PLWH应与普通人群一样有机会接受HSCT。目前尚无针对PLWH进行HSCT管理的指南，我们希望通过本文提供初步指导。
我们对已发表的英文文献进行了非系统性综述，内容涉及PLWH和HSCT受者的药物及机会性感染风险管理，以及地方、国家和国际指南。然后，我们为接受HSCT的PLWH制定了建议，并与作者和专家同行进行了多轮审核。
预计HIV病情得到良好控制的患者接受HSCT的结果与未感染HIV的人相似。重点应是尽量减少抗逆转录病毒治疗的中断，避免药物相互作用（整合酶链转移抑制剂可将其降至最低），并管理重叠的毒性。晚期HIV和HSCT中常见的机会性感染包括肺炎、弓形虫病单纯疱疹病毒、水痘带状疱疹病毒和巨细胞病毒，非结核分枝杆菌和隐球菌病在晚期HIV中更为常见。假设患者的HIV病情得到良好控制，大多数机会性感染风险是由于移植相关的免疫抑制引起的，我们提供了具体的预防建议。
PLWH应与未感染HIV的人一样有机会接受HSCT，我们提供本文作为指导，以支持血液学/肿瘤学提供者。
