Organ Transplantation in HIV-Infected Patients

Advances in antiretroviral therapy have transformed HIV from a fatal illness into a chronic condition, unmasking a growing burden of end-stage organ disease among people with HIV. Once considered contraindicated, solid‐organ transplantation is now feasible in selected HIV-infected patients under strict virological control. Rigorous recipient assessment includes stable viral suppression, adequate CD4+ counts and absence of opportunistic infections. Immunosuppressive regimens must be tailored to mitigate drug–drug interactions with antiretroviral agents, and vigilant therapeutic drug monitoring is essential. Early and mid-term outcomes for kidney and liver transplants in HIV-positive recipients approximate those in HIV-negative cohorts, though rejection rates remain modestly elevated. Emerging practice includes transplantation from HIV-positive donors to HIV-positive recipients, expanding the donor pool while raising considerations of donor viral diversity and potential superinfection. Multidisciplinary collaboration among transplant surgeons, infectious disease specialists and pharmacologists underpins safe delivery of this life-saving therapy. Globally, the field is evolving through policy initiatives that facilitate HIV-positive donor programmes, and ongoing research aims to refine immunosuppression, prevent viral complications and promote equitable access for all eligible patients.

Research from Nature Portfolio

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Organ Transplantation in HIV-Infected Patients publication trend

The graph below shows the total number of articles in organ transplantation in hiv-infected patients across all publications each year (not limited to Nature Index journals).

Technical terms

HIV donor-to-recipient transplantation (HIV D+/R+): Organ transplantation between an HIV-positive donor and an HIV-positive recipient under regulatory frameworks that permit such procedures.

Superinfection: Acquisition of a new HIV strain in a person already infected, which may complicate antiretroviral management and resistance profiling.

Immunosuppressive therapy: Use of drugs such as tacrolimus, mycophenolate mofetil or corticosteroids to prevent graft rejection by dampening the recipient’s immune response.

Drug–drug interactions (DDIs): Pharmacological interactions between antiretroviral agents and immunosuppressants that can alter drug levels and therapeutic effect.

Graft survival: Duration during which the transplanted organ functions without irreversible loss, reflecting both immunological and non-immunological factors.

References

1. HOPE springs eternal: lack of HIV superinfection in HIV Organ Policy Equity Act kidney transplants. Journal of Clinical Investigation (2024).
2. Evaluating Challenges in Access To Transplantation for Persons with HIV. Current HIV/AIDS Reports (2025).
3. Switch from a ritonavir to a cobicistat containing antiretroviral regimen and impact on tacrolimus levels in a kidney transplant recipient. Virology Journal (2023).