Dataset Information

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls.

ABSTRACT:

Objectives

To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients.

Design

Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls.

Methods

We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models.

Results

There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P < 0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P = 0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P = 0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P = 0.07) and HR 1.4 (P = 0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis.

Conclusion

Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest.

Trial registration

ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.

SUBMITTER: Roland ME

PROVIDER: S-EPMC4957135 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Publications

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls.

Roland Michelle E ME Barin Burc B Huprikar Shirish S Murphy Barbara B Hanto Douglas W DW Blumberg Emily E Olthoff Kim K Simon David D Hardy William D WD Beatty George G Stock Peter G PG

AIDS (London, England) 20160101 3

<h4>Objectives</h4>To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients.<h4>Design</h4>Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls.<h4>Methods</h4>We fit proportional hazards models to assess transplantation impact on mortality among recipients and candid ...[more]

PMID: 26765937

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Project description:BACKGROUND:Sub-Saharan Africa is endemic for intestinal parasites and distinguished for the largest burden of HIV cases. Blastocystis sp. is one of the most common protists infecting humans but its role in human disease is still controversial. Aim of this study was to investigate the prevalence of Blastocystis sp. in HIV positive and negative adults in Ghana and its association with immune status and other risk factors. METHODS:122 HIV positive outpatients and 70 HIV negative blood donors from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were included in the present study. Demographic, clinical and laboratory data were collected and HIV positive patients distinguished for CD4+ T cell count <200 cells/?l (n = 54) and >200 cells/?l (n = 68). A Blastocystis's phylogenetic analysis was performed to determine sample subtype (ST). RESULTS:The prevalence of Blastocystis sp. in adult HIV positive individuals was lower than in HIV negative persons (6.6% vs. 20.0%, p = 0.008) and Blastocystis sp. ST1 was the most prevalent strain. Within HIV positive participants, the prevalence of Blastocystis sp. was lower in those individuals with CD4+ T cell count <200 cells/?l than in patients with higher CD4+ T cell count (1.9% vs. 10.3%, p = 0.076). Multiple regression analysis revealed that Blastocystis sp. was inversely associated with an obese Body Mass Index (BMI) in HIV negative persons (p = 0.040). Presence of Blastocystis sp. was correlated with higher CD4+ T cell count in HIV positive participants (p = 0.049). CONCLUSION:It is largely reported that people living with HIV (PLHIV) in Africa are affected from parasite infections and that co-infections may adversely impact on their immune status, accelerating progress to AIDS and worsening gastrointestinal manifestations. Differently, in this study Blastocystis sp. was associated with a better immune status jointly with a healthy body weight while it seems to be reduced with the progression of HIV infection. This data agree with recent suggestions that Blastocystis sp. can represent a component of the healthy gut microbiota.

Dataset Information

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls.

Objectives

Design

Methods

Results

Conclusion

Trial registration

Publications

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls.

Similar Datasets

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