Evidence-based medicine: the dilemma of transplantation in patients with HIV infection

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Abstract
Purpose of review Because data on survival of HIV-infected recipients are too sparse, valid conclusions cannot be drawn. If centers want to offer transplantation to HIV-infected candidates, we must select factors that define subgroups likely to have good outcomes and those unlikely to benefit. Recent findings Transplantation in patients with HIV before 1996 appeared to hasten progression to AIDS and death. The advent of highly active antiretroviral treatment has dramatically improved survival of patients with HIV infection since 1996. Fewer are dying of opportunistic infections or HIV-related cancers, and a higher percentage is dying of unrelated conditions, such as organ failure. Several studies have reported survival rates of HIV-infected recipients comparable with those of uninfected patients. Summary Most HIV-infected transplant candidates will not survive to receive a transplant under current listing criteria, especially those with hepatitis C co-infection and those of African descent with HIV-associated nephropathy. This may suggest the need for modification of the prioritization system for transplantation to improve survival in this population.