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Cardiology in focus
Cardiac transplantation in people living with HIV: the global context
  1. Oyinkan Osobamiro1,
  2. April Stempein-Otero2,
  3. Isaac Ssinabulya3,
  4. Christopher Longenecker4
  1. 1 Internal Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Cardiology, University of Washington, Seattle, Washington, USA
  3. 3 Cardiology, Uganda Heart Institute, Kampala, Uganda
  4. 4 Cardiology and Global Health, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Christopher Longenecker, Cardiology, University of Washington, Seattle, WA 98195, USA; ctlongen{at}uw.edu

https://doi.org/10.1136/heartjnl-2021-320463

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    Introduction

    In 2013, the passage of the HOPE act allowed HIV-positive recipients to receive organs from HIV-positive donors under the auspices of research studies. This historic act, meant to increase the availability of donor organs to people living with HIV (PLWH), was a significant acknowledgement that, due to combination antiretroviral therapy (ART), HIV is no longer a life-limiting disease. Rather, PLWH are living near normal lifespans and developing other diseases of ageing such as coronary artery disease or heart failure (HF). Furthermore, PLWH develop cardiovascular disease more frequently and at younger ages due to a complex interplay of socioeconomic and disease-specific risk factors. The increased prevalence of end-stage heart disease within this vulnerable group makes equitable access to advanced heart therapies a matter of clinical urgency. This paper will focus on the role of cardiac transplantation for PLWH, with special emphasis on the global context.

    The historical context for solid organ transplantation in PLWH

    Most data on solid organ transplantation in PLWH come from the kidney and liver transplantation literature. With effective ART, kidney and liver transplant has now become the standard of care among PLWH with end-stage disease in high-income countries. Initial fears of increased rates of infection leading to higher morbidity and mortality among PLWH were proven to be unfounded.1 For example, 1-year survival is similar for PLWH who receive a kidney transplant, regardless of whether the donor is HIV positive or HIV negative (HIV D+/R+ vs HIV D+/R−).1 Similarly, for liver transplantation among PLWH, outcomes continue to improve, even in those with coinfection with other viruses. PLWH alone have comparable liver transplantation outcomes as HIV-negative individuals, and patients with both HIV and hepatitis C virus (HCV) …

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    Footnotes

    • Twitter @hivcardiodoc

    • Contributors All authors contributed to the drafting of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Commissioned; internally peer reviewed.