Better Kidney Transplant Outcomes in Patients with HIV than Hepatitis C

HIV patients need to have undetectable viral load to undergo procedure.

HIV patients need to have undetectable viral load to undergo procedure.

Patients with HIV who receive a kidney transplant experience superior outcomes compared with transplant patients with hepatitis C virus (HCV) and in those with an HIV/HCV co-infection, a recent study found.

The study, published online recently in Kidney International, evaluated 124,035 adult patients who received a kidney transplant between 1996 and 2013. The researchers found the 3-year survival rate in HIV patients was 89%, which was similar to the rate of 90% in the uninfected patient group.

Meanwhile, the 3-year survival rates in HCV patients was 84% and the survival rate in co-infected patients was 73%. The study was the largest retrospective evaluation of outcomes in kidney transplant patients infected with HIV.

Patients infected with HIV must have an undetectable viral load to receive a transplant, however an undetectable viral load is not required for HCV patients. Furthermore, fewer than 25% of centers in the United States provide kidney transplant to HIV patients.

Overall, fewer patients with HIV undergo kidney transplants compared with HCV patients and uninfected patients.

"These findings show that HIV patients are being unfairly perceived to have worse kidney transplant outcomes than non-infected groups, and as a result, they often have to wait the longest for transplants and there are fewer living donors," lead author Deirdre Sawinski, MD, said in a press release. "Our hope is that these study findings result in greater access to transplantation for HIV patients, while also inspiring the kidney transplant community to focus on eradicating hepatitis C in transplant patients -- either pre-transplant or if that's not possible, immediately post-transplant -- to ensure better outcomes for these patients."

Current treatment standards recommend kidney transplants as the preferred treatment in HCV patients, compared with ongoing dialysis treatment. However, these patients experience worse outcomes compared with uninfected patients.

In light of the recent approval of significant HCV antiviral agents, physicians can better treat the virus either prior to or immediately following a transplant.