Renal transplantation in HIV-infected patients is associated with graft and overall survival rates similar to those of HIV-negative patients, except in cases of co-infection with hepatitis C virus (HCV), according to a new study.
The study, led by Jayme E. Locke, MD, of the University of Alabama at Birmingham, is the first national study examining outcomes among the entire U.S. cohort of HIV-positive kidney transplant recipients and comparing their outcomes to appropriately matched HIV-negative controls.
The study included 510 HIV-infected renal transplant patients and 94,948 HIV-negative controls. The 5- and 10-year graft survival among the HIV-infected patients was 68.9% and 49.5%, respectively, but was highest among those who were infected only with HIV (mono-infected) but not HCV (75% and 55.9%, respectively), Dr. Locke and colleagues reported online ahead of print in the Journal of the American Society of Nephrology. Among patients co-infected with HIV and HCV, the 5- and 10-year graft survival rates were 49.9% and 25.9%, respectively.
The researchers compared the HIV group with a matched group of HIV-negative controls. Compared with the control group, the HIV-infected patients overall had significantly lower 5- and 10-year graft survival rates (69.2% vs. 75.3% and 49.8% vs. 54.4%, respectively). The 5- and 10-year graft survival rates did not differ significantly between mono-infected HIV patients and controls (75.0% vs. 75.8% and 55.9% vs. 56.0%, respectively). The 5- and 10-year survival rates were significantly worse for patients co-infected with HIV and HCV than for matched HIV-negative controls infected with HCV (52.0% vs.64.0% and 27.0% vs. 36.2%, respectively).
Patient survival rates among all HIV-infected recipients were 83.3% and 51.5% at 5 and 10 years, respectively. The rates were higher among the mono-infected HIV patients (88.7% and 63.5%, respectively) than the co-infected patients (66.3% and 29.3%).
Additionally, compared with appropriately matched HIV-negative controls, the HIV-infected patients had similar 5-year patient survival rates (83.5% and 86.2%), but significantly lower 10-year survival rates (51.6% vs. 72.1%). The 5- and 10-year patient survival rates did not differ significantly between the mono-infected HIV patients and HIV-negative/HCV-negative controls (88.7% and 89.1% and 63.5% and 77.6%). Co-infected patients, however, had significantly worse survival at 5 and 10 years compared with HIV-negative/HCV-positive controls (67.0% vs.78.6% and 29.3% vs. 56.2%, respectively).