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Kidney transplantation in a patient with HIV disease
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This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.
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/mm3 and men with less than 400 cells/mm3. 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.[45]
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
- Kidney transplantation in a patient with HIV disease. Indian J Nephrol. 2009;19:77-9.
- [Google Scholar]
- 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.
- [Google Scholar]
- Hepatotoxicity associated with nevirapine use. J Acquir Immune Defic Syndr. 2004;35:538-9.
- [Google Scholar]
- 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]
- 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]
- [Google Scholar]
