PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of ijnephrolHomeCurrent issueInstructionsSubmit article
 
Indian J Nephrol. 2009 July; 19(3): 126.
PMCID: PMC2859481

Kidney transplantation in a patient with HIV disease

Sir,

I have read with great interest the article from Bansai et al.[1] I agree that we are now able to offer good alternatives to HIV patients transplanting kidney or liver apart from conservative management. However, I disagree with the antiretroviral regimen. It is well known that new PI's are preferable than old ones and nevirapine.[2] The only point is that you need to check serum antiretroviral levels at least for several weeks after kidney transplantation in order to achieve a suitable dose and dose interval. For instance, with lopinavir/ritonavir (LPV/r), frequently a more prolonged interval of dose and dose lowering is needed. Today, nevirapine is used only in children below 6 months of age, women with CD4 count below 250 cells/mm3 and men with less than 400 cells/mm3. With higher CD4 count, severe hepatotoxicity has been described. In some cases, hepatic injuries continued to progress despite discontinuation of nevirapine.[3] International guidelines do not recommend the regimen for this patient.[4,5]

I would like to emphasize that serum levels of antiretroviral drugs may help to achieve the best outcome for kidney transplantation in HIV patients.

References

1. Bansal SB SM, Ahlawat R, Kher V. Kidney transplantation in a patient with HIV disease. Indian J Nephrol. 2009;19:77–9. [PMC free article] [PubMed]
2. Crane H, Van Rompaey S, Kitahata M. Initiating highly active antiretroviral therapy with newer protease inhibitors is associated with better survival compared to first-generation protease inhibitors or nevirapine. AIDS Patient Care STDS. 2007;21:920–9. [PubMed]
3. Baylor M, Johann-Liang R. Hepatotoxicity associated with nevirapine use. J Acquir Immune Defic Syndr. 2004;35:538–9. [PubMed]
4. Who library cataloguing-in-publication data. Antiretroviral therapy for hiv infection in adults and adolescents: recommendations for a public health approach. Available from http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf. [last accessed on 2006 Jul 10]
5. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. November 3. Available from http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. [Last accessed on 2008 Jul 10] [PubMed]

Articles from Indian Journal of Nephrology are provided here courtesy of Wolters Kluwer -- Medknow Publications