Исследование: Пересадка почки от ВИЧ-инфицированного донора не несет дополнительного риска для ВИЧ-позитивного пациента
South Africa has one of the highest incidences of human immunodeficiency virus (HIV) infection in Africa. The rollout of antiretroviral therapy (ART) in South Africa has been tremendously successful in extending the lives of HIV-infected persons. Consequently, more patients who would have died before the availability of ART are now receiving a diagnosis of HIV-associated nephropathy.
The rates of disease progression and death in the population of HIV-positive patients with chronic kidney disease can be modified by ART, which reduces the risk of advanced chronic kidney disease among patients with HIV-associated nephropathy by approximately 60%.2,3 It has been estimated that the prevalence of chronic kidney disease among HIV-infected patients receiving treatment is between 8% and 22%4-7; among untreated patients, it is estimated to be between 20% and 27%.8,9 Confronted with a high burden of HIV disease and limited resources, South Africa faces considerable challenges in providing renal-replacement therapy for the large numbers of HIV-infected persons in whom chronic kidney disease will develop during their lifetime.
State-funded renal-replacement programs in South Africa have limited resources. Previous reports showing that outcomes in HIV-infected recipients who have received a transplant are equivalent to those in other high-risk candidates argued strongly for HIV-infected patients to be considered as candidates for renal-replacement therapy.10,11 In 2008, in response to the clinical need of our patients and to the fact that HIV infection was considered to be a contraindication to acceptance for dialysis treatment or receipt of a kidney from an HIV-seronegative donor, we performed four renal transplantations in HIV-positive recipients using kidneys from HIV-infected donors. The preliminary results from that study showed 100% graft survival and patient survival at 1 year.12 We now present the 5-year follow-up for these patients and for additional recipients in the HIV-positive–to–HIV-positive renal transplantation program at Groote Schuur Hospital, Cape Town.
