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Renal transplantation in an HIV-2 positive recipient in Portugal

Keywords: antiretroviral therapy, hiv-2 infection, immunosuppressive therapy, kidney transplantation.

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Abstract:

the improvement of combined antiretroviral therapy regimens has made solid organ transplantation a therapeutic option for patients with human immunodeficiency virus (hiv) infection. generally, hiv-2 infectionpresents a slower clinical progression and immunological degradation than hiv-1. hiv-2 infection treatment can be challenging when a complex immunosuppressive regimen is combined with antiretroviraltherapy. the authors report the first case in portugal of renal transplantation in an hiv-2 patient. a 54-year-old man from guinea-bissau was diagnosed with hiv-2 infection on starting haemodialysis in portugal in 1998. at diagnosis, hiv infection staging revealed undetectable plasma hiv- 2 rna and t-cell cd4 counts of 808 cells/μl, with no need for combined antiretroviral therapy during follow-up. the patient underwent renal transplantation from a deceased donor in march 2011. he developed delayed graft function and started therapy with methylprednisolone and thymoglobulin. the patient gradually recovered renal function and was discharged after two weeks with serum creatinine of 2.3 mg/dl. the hiv-2 rna levels remained undetectable, but t-cell cd4count decreased to less than 200 cells/μl and combined antiretroviral therapy with abacavir, lamivudine and raltegravir was started. nine months after transplantation, the patient has a serum creatinine of 1.5 mg/dl and a nonreplicating hiv status

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