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| LETTER TO EDITOR |
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| Year : 2009 | Volume
: 19
| Issue : 3 | Page : 126 |
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Kidney transplantation in a patient with HIV disease
LI Gonzalez-Granado
Immunodeficiencies Unit, Hospital 12 de Octubre, Avenida Andalucia S/N, 28041, Madrid, Spain
| Date of Web Publication | 15-Oct-2009 |
Correspondence Address:
L I Gonzalez-Granado
Calle Pizarro 2, 3 deRecha. 47006, Valladolid
Spain
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-4065.57113
How to cite this article:
Gonzalez-Granado L I. Kidney transplantation in a patient with HIV disease. Indian J Nephrol 2009;19:126 |
Sir,
I have read with great interest the article from Bansai et al. [1] I agree that we are now able to offer good alternatives to HIV patients transplanting kidney or liver apart from conservative management. However, I disagree with the antiretroviral regimen. It is well known that new PI΄s are preferable than old ones and nevirapine. [2] The only point is that you need to check serum antiretroviral levels at least for several weeks after kidney transplantation in order to achieve a suitable dose and dose interval. For instance, with lopinavir/ritonavir (LPV/r), frequently a more prolonged interval of dose and dose lowering is needed. Today, nevirapine is used only in children below 6 months of age, women with CD4 count below 250 cells/mm 3 and men with less than 400 cells/mm 3 . With higher CD4 count, severe hepatotoxicity has been described. In some cases, hepatic injuries continued to progress despite discontinuation of nevirapine. [3] International guidelines do not recommend the regimen for this patient. [4],[5]
I would like to emphasize that serum levels of antiretroviral drugs may help to achieve the best outcome for kidney transplantation in HIV patients.
| References | |  |
| 1. | Bansal SB SM, Ahlawat R, Kher V. Kidney transplantation in a patient with HIV disease. Indian J Nephrol 2009;19:77-9.   |
| 2. | Crane H, Van Rompaey S, Kitahata M. Initiating highly active antiretroviral therapy with newer protease inhibitors is associated with better survival compared to first-generation protease inhibitors or nevirapine. AIDS Patient Care STDS 2007;21:920-9. |
| 3. | Baylor M, Johann-Liang R. Hepatotoxicity associated with nevirapine use. J Acquir Immune Defic Syndr 2004;35:538-9. |
| 4. | Who library cataloguing-in-publication data. Antiretroviral therapy for hiv infection in adults and adolescents: recommendations for a public health approach. Available from http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf . [last accessed on 2006 Jul 10]. |
| 5. | Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. November 3. Available from http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. [Last accessed on 2008 Jul 10]. |
| This article has been cited by | | 1 |
Reply to kidney transplantation in a patient with HIV disease |
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| Bansal, S.B., Singhal, M., Ahlawat, R., Kher, V. | | Indian Journal of Nephrology. 2009; 19(4): 175 | | [Pubmed] | |
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Editorial Board
