Abstract：
BACKGROUND: Human immunodeficiency virus (HIV) is no longer considered a contraindication for kidney transplantation (KT). KT management in HIV patients is a complex process with challenges, such as drug interactions between immunosuppression and antiretroviral (ARV) therapy. In our country, no KT has been performed thus far in this category of patients.
METHODS: We present the case of a 29-year-old female patient with HIV and end-stage renal disease (ESRD) who performed a KT from a related living donor in March 2022. KT immediate evolution was favorable. No transplant-related complications were reported. HIV viral load remained undetectable and CD4+ T cells were constantly > 500 cell/ μL, during the 18 months of follow-up. The main challenge in our case was the drug interaction between the protease inhibitor-based regimen and tacrolimus. This led to tacrolimus overdose, and, subsequently, change in ARV therapy. ARV switching was performed on a regimen based on integrase inhibitor and nucleoside reverse transcriptase inhibitors. After the ARV change, the therapeutic level of tacrolimus was easily reached and maintained. Kidney graft function remained normal during follow-up, despite tacrolimus overexposure, and no rejection or anti-HLA antibodies were observed. Another challenge was related to the donor\'s hepatitis C virus status (positive antibodies, negative nucleic acid test). The recipient did not develop seroconversion or detectable viremia at 3-, 6-, 12- and 18-months post-KT.
CONCLUSIONS: We reported the first case of a successful KT in an ESRD patient with HIV in Romania, in whom the post-transplant evolution was favorable.
METHODS: We present the case of a 29-year-old female patient with HIV and end-stage renal disease (ESRD) who performed a KT from a related living donor in March 2022. KT immediate evolution was favorable. No transplant-related complications were reported. HIV viral load remained undetectable and CD4+ T cells were constantly > 500 cell/ μL, during the 18 months of follow-up. The main challenge in our case was the drug interaction between the protease inhibitor-based regimen and tacrolimus. This led to tacrolimus overdose, and, subsequently, change in ARV therapy. ARV switching was performed on a regimen based on integrase inhibitor and nucleoside reverse transcriptase inhibitors. After the ARV change, the therapeutic level of tacrolimus was easily reached and maintained. Kidney graft function remained normal during follow-up, despite tacrolimus overexposure, and no rejection or anti-HLA antibodies were observed. Another challenge was related to the donor\'s hepatitis C virus status (positive antibodies, negative nucleic acid test). The recipient did not develop seroconversion or detectable viremia at 3-, 6-, 12- and 18-months post-KT.
CONCLUSIONS: We reported the first case of a successful KT in an ESRD patient with HIV in Romania, in whom the post-transplant evolution was favorable.
摘要：
背景：人类免疫缺陷病毒（HIV）不再被认为是肾移植（KT）的禁忌症。HIV患者的KT管理是一个充满挑战的复杂过程,如免疫抑制和抗逆转录病毒（ARV）治疗之间的药物相互作用。在我们国家,到目前为止，尚未在此类患者中进行KT。
方法：我们介绍了一名29岁的HIV和终末期肾病（ESRD）女性患者，该患者于2022年3月从相关活体供体进行了KT。KT立即进化是有利的。未报告移植相关并发症。HIV病毒载量仍然检测不到，CD4+T细胞持续>500细胞/μL，在18个月的随访期间。我们案例中的主要挑战是基于蛋白酶抑制剂的方案与他克莫司之间的药物相互作用。这导致他克莫司过量,and,随后,ARV治疗的变化。基于整合酶抑制剂和核苷逆转录酶抑制剂的方案进行ARV转换。ARV变更后，他克莫司的治疗水平很容易达到和维持。随访期间肾移植功能保持正常，尽管他克莫司过度暴露,并且没有观察到排斥反应或抗HLA抗体。另一个挑战与捐赠者的丙型肝炎病毒状态有关(阳性抗体，阴性核酸测试)。接受者在3-时没有出现血清转化或可检测到的病毒血症，6-，KT后12个月和18个月。
结论：我们报告了罗马尼亚一名ESRDHIV患者成功实施KT的首例病例，移植后的进化是有利的。
方法：我们介绍了一名29岁的HIV和终末期肾病（ESRD）女性患者，该患者于2022年3月从相关活体供体进行了KT。KT立即进化是有利的。未报告移植相关并发症。HIV病毒载量仍然检测不到，CD4+T细胞持续>500细胞/μL，在18个月的随访期间。我们案例中的主要挑战是基于蛋白酶抑制剂的方案与他克莫司之间的药物相互作用。这导致他克莫司过量,and,随后,ARV治疗的变化。基于整合酶抑制剂和核苷逆转录酶抑制剂的方案进行ARV转换。ARV变更后，他克莫司的治疗水平很容易达到和维持。随访期间肾移植功能保持正常，尽管他克莫司过度暴露,并且没有观察到排斥反应或抗HLA抗体。另一个挑战与捐赠者的丙型肝炎病毒状态有关(阳性抗体，阴性核酸测试)。接受者在3-时没有出现血清转化或可检测到的病毒血症，6-，KT后12个月和18个月。
结论：我们报告了罗马尼亚一名ESRDHIV患者成功实施KT的首例病例，移植后的进化是有利的。
