Although 1- and 3-year survival outcomes did not differ significantly among kidney transplant recipients with and without HIV, the difference in survival was significant at 5 years, highlighting the need for long-term management strategies and tailored monitoring among HIV-positive patients.
Although patients with and without HIV infection have similar short- and medium-term survival outcomes following kidney transplantation (KT), long-term survival outcomes differ significantly, according to study results published in BMC Infectious Diseases.
The HIV Organ Policy Equity (HOPE) Act was passed in 2013 in the United States as an initiative to conduct large-scale clinical trials of KT outcomes in HIV.
To compare KT outcomes among patients with and without HIV, investigators conducted a systematic review and meta-analysis, searching publication databases for relevant studies published between 1990 and 2024. The primary outcome was recipient survival post-KT.
The final analysis included data from 49 publications, which were retrospective (n=43) or prospective (n=6) observational studies. The pooled study population comprised 6174 patients with HIV who underwent KT.
Post-transplantation survival rates were 94% (95% CI, 92.9-95.0; P =.97) at 1 year, 89.2% (95% CI, 87.1-91.0; P =.06) at 3 years, and 82.8% (95% CI, 76.5-87.6; P =.002) at 5 years.
Compared with non-HIV KT recipients, survival among patients with HIV did not differ significantly at 1 year (hazard ratio [HR], 1.43; 95% CI, 0.96-2.12; P =.08) and 3 years (HR, 1.10; 95% CI, 0.80-1.51; P =.56). However, the difference in survival was significant at 5 years (HR, 1.91; 95% CI, 1.22-3.00; P <.0001).
Post-transplantation graft survival rates were 90.2% (95% CI, 88.8-91.5; P =.97) at 1 year, 77.9% (95% CI, 72.7-82.3; P <.0001) at 3 years, and 70.5% (95% CI, 64.2-76.1; P =.02) at 5 years.
Compared with non-HIV KT recipients, graft survival was worse at 1 year (HR, 2.11; 95% CI, 1.50-2.96; P <.0001) and 3 years (HR, 1.89; 95% CI, 1.18-3.01; P =.01) among patients with HIV, but the difference in graft survival was ameliorated at 5 years (HR, 1.76; 95% CI, 0.90-3.45; P =.10).
Graft rejection rates in patients with HIV were 25.6% (95% CI, 18.3-34.4; P <.0001) at 1 year, 32.7% (95% CI, 22.9-44.2; P <.004) at 3 years, and 38.5% (95% CI, 28.3-49.8; P <.0001) at 5 years. Graft rejection was higher among patients with vs without HIV at 1 year (HR, 1.88; 95% CI, 1.45-2.44; P <.0001) and 5 years (HR, 2.29; 95% CI, 1.26-4.17; P =.01).
In a multivariate meta-regression subgroup analysis, patient survival was moderated by mean pretransplantation CD4+ count (estimate, 0.004; P <.0001). Graft survival at 1 year was moderated by protease inhibitor antiretroviral therapy use (estimate, 0.61; P =.004) and hepatitis C coinfection (estimate, -0.92; P =.012). Additionally, graft survival after 5 years was moderated by hepatitis C coinfection (estimate, -1.09; P =.004). Further, graft rejection at 1 year was moderated by viral suppression status (estimate, 0.79; P =.046).
Study limitations include underrepresentation of data from low- and middle-income countries.
The investigators concluded, “The findings underscore the importance of long-term management strategies, particularly in mitigating the survival disadvantages observed beyond five years.”
By Jessica Nye, PhD
References:
Leung KC, Ng WWS, Ciofani J, Kwok W. Survival of kidney transplantation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infect Dis. Published online September 26, 2025. doi:10.1186/s12879-025-11480-7
Source : Infectious Disease Advisor
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