Renal transplantation associated with HIV infection: A Saudi Arabian experience and review of the literature

Of 504 kidney transplant recipients attending our center, 6 developed serological evidence of human immunodeficiency virus (HIV) infection (1.2%). All 6 patients had been transplanted abroad. Of those, 3 died (mean time from transplantation to death 37 months), 2 having developed full-blown AIDS and the 3rd from opportunistic infections related to immunosuppressive drugs. Of the remaining 3, one developed Kaposi's sarcoma (KS) which responded to reduction in immunosuppression, but this patient was subsequently lost to follow-up. The other 2 are asymptomatic with stable renal function. Sixty cases with HIV infection reported in the World Literature were reviewed. The incidence of Western blot positivity among renal transplant recipients ranged from 0.12% to 6.12%. Accelerated course of HIV disease was observed in this population, particularly in those who were HIV-seropositive prior to transplantation. This study reviews various aspects of HIV infection in renal transplant recipients, including route of infection, natural history of the disease, effect of immunosuppression, allograft function, and whether opportunistic infections are related to immunosuppressive drugs or HIV infection.