Indraprastha Apollo Hospital, India
Title: Renal transplantation in HIV patients
D. K. Agarwal has 22 years of experience in the field of Nephrology including specialization in renal transplant, haemodialysis, CAPD and all kidney problems and diseases along with critical kidney patients with emergency management. He is well experienced in handling kidney patients with diabetes and hypertension and other diseases. He worked as senior consultant, nephrologist in various institutes of national and international repute like Nizam's Institute of Medical Sciences, Hyderabad, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, etc. He is experienced at division of Nephrology, Department of Medicine, University of Missouri, School of Medicine, Columbia, USA.
Human immunodeficiency virus (HIV) has been a major global health problem for longer than three decades. With the advent of HAART or cART (combined anti retroviral therapy) and effective prophylaxis against opportunistic infections survival has increased markedly. Hence morbidity from other diseases like end stage liver disease, renal and heart disease is increasing rapidly. Presence of HIV infection was regarded as a contraindication for renal transplantation for fear of exacerbating an already immunocompromised state further with immunosuppressant´s, use of limited supply of donor organs in individuals with unknown outcome and also the risk of spread of infection to health care staff. HIV related kidney disease is now becoming a relatively common cause of ESRD requiring dialysis because of its rapid progression to AIDS and high mortality on dialysis renal transplantation was attempted at various centers across the globe in HIV infected patients with good success rate allaying initial fears. Our experience in kidney transplantation of HIV patients are enthusiastic with very good patient and graft survival at par with non-HIV patients. HIV infection is now no longer a contraindication to renal transplantation and is being considered standard therapy. We found no difference in the use of cyclosporine versus tacrolimus in HIV infected patients. There has been a specific protocol before introducing such a patient for renal transplantation including HIV RNA negativity and CD4 counts > 200 for four months and absence of opportunistic infections. There was no recurrence of the disease in our patients.