HIV and Transplant
Key Points
- People with HIV can successfully donate or receive transplanted organs with reasonable success rates using the appropriate protocols.
- For people with HIV who are receiving a transplant, health care providers should consider and monitor potential drug interactions, kidney and liver function, and HIV viral suppression.
- People with HIV should continue to take all prescribed HIV medicines before and after transplant, unless directed otherwise by their health care provider.
Can people with HIV get a transplant?
While there are some limitations, people with HIV can get a transplant, including both solid organ transplant (SOT) and hematopoietic cell transplant (HCT). With modern HIV medicines, transplants are relatively common and safe for people with HIV under normal circumstances.
In fact, some evidence suggests that allogeneic HCT can reduce the amount of HIV in recipients with certain donors. In contrast, people with HIV may be less likely to get referred for transplant if they also have end-stage renal disease (ESRD), even though kidney transplant appears to be more effective than dialysis for people with HIV and ESRD.
Can people with HIV donate organs?
As of 2013, people with HIV can donate organs in the United States as a result of the HIV Organ Policy Equity (HOPE) Act. However, organs donated from people with HIV can only be provided to recipients who also have HIV. By donating organs, people with HIV can help ensure that other people with HIV have organs available if needed.
To support improved access to transplants in alignment with the HOPE Act, the U.S. Department of Health and Human Services amended the requirements for clinical trial enrollment or Institutional Review Board approval for transplants in people with HIV, further enhancing access to these services.
People with HIV and other opportunistic infections (such as viral hepatitis) may not be eligible to donate organs. In addition, organ donors with HIV should be screened for drug resistance to HIV medicines to make sure HIV treatment will continue to be successful for the transplant recipient.
How is a transplant different for people with HIV?
Transplant can be different for people with HIV whether serving as a donor or recipient. For both recipients and donors, additional testing may be necessary to ensure safety both before (such as drug resistance testing) and after (such as kidney or liver function) transplant.
In addition, health care providers must rigorously review both HIV and non-HIV medicines before transplant. In some cases, changes to HIV medicines may be necessary. However, these changes should allow people with HIV to continue taking their HIV medicines to maintain adequate immune function before and after transplant, whenever possible.
Before a transplant, health care providers should ensure people with HIV have maintained HIV viral suppression, meaning that the levels of HIV in the blood are undetectable. This allows the immune system to function properly by protecting the body’s infection-fighting CD4 cells (CD4 T lymphocytes).
Because people who receive transplants are likely to experience significantly reduced immune function (called immunosuppression), health care providers should continue monitoring viral suppression after the transplant occurs.
Can people with HIV and viral hepatitis get a transplant?
While people with HIV can get or receive a transplant, health care providers often test for opportunistic infections like hepatitis B virus (HBV) and hepatitis C virus (HCV) before referring someone for a transplant. In general, these forms of hepatitis are more common in people with HIV, making them more important to consider due to potential health implications.
People with HIV and viral hepatitis can still receive a transplant but should follow specific medication guidelines; people with HBV should take an anti-HBV medicine (such as tenofovir alafenamide or entecavir) whereas people with HCV should be treated with direct-acting antivirals. Of note, transplant eligibility may be more dependent on the organ being transplanted in people with HIV and viral hepatitis.
What are the main considerations for transplants in people with HIV?
People with HIV require some special considerations before donating or receiving a transplant. For donors with HIV, considerations include evaluation of HIV drug resistance and other infections. For transplant recipients with HIV, additional considerations might include:
- Using health care providers with different specializations
- Maintaining HIV viral suppression
- Preventing post-transplant infections
- Monitoring kidney and liver function
- Monitoring drug effectiveness
- Considering pill burden (how many pills a person has to take)
- Maintaining, modifying, or changing HIV medicines to minimize drug interactions
These considerations help to ensure that people with HIV have better access to safe and effective transplants. With these considerations, transplants can often be safe and effective for people with HIV.
This fact sheet is based on information from the following sources:
From the Organ Procurement and Transportation Network:
From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:
- Guidelines for the Use of Antiretrovirals in Adults and Adolescents With HIV:
From National Institute of Allergy and Infectious Disease:
From CDC:
From Medline Plus:
Also see the HIV Source collection of HIV links and resources.