Heart Transplantation in Human Immunodeficiency Virus–Positive Patients
Received 26 November 2008; received in revised form 17 March 2009; accepted 7 April 2009. published online 08 May 2009.
Background
Human immunodeficiency virus (HIV) infection is widely considered a contraindication for cardiac transplantation. However, with the newer anti-retroviral drugs, the estimated 10-year survival after seroconversion is exceeds 90%. This case series describes the intermediate range outcome of HIV-positive cardiac transplant recipients.
Methods
A retrospective analysis of 1679 cardiac transplant patients was undertaken to identify HIV-positive recipients.
Results
Seven patients were identified. Five (4 men) were diagnosed with HIV before transplantation and 2 patients seroconverted after transplantation. Dilated cardiomyopathy was the indication for transplant in all patients. The 5 HIV recipients were aged 42 ± 8 years, and time after HIV seroconversion averaged 9.5 years. All underwent cardiac transplantation as high-risk candidates. The CD4 count was 554 ± 169 cells/μl, and viral load was undetectable in all patients at the time of transplantation. Two patients seroconverted to HIV-positive status at 1 and 7 years after transplant. No AIDS-defining illness was observed in any patient before or after transplant. Six patients received highly active anti-retroviral therapy. Viral load remained low in the presence of immunosuppression. All patients are alive with a follow-up from transplant of 57 ± 78.9 months.
Conclusion
Excellent intermediate term outcome is noted in carefully selected HIV-positive patients. No significant AIDS-related infections or complications occurred.
aDivision of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
bDivision of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
Reprint requests: Donna Mancini, MD, 622 W 168 St, New York, NY 10032. Telephone: 212-305-4629. Fax: 212-305-2591
ABSTRACT