HOPE in Action KT: Infections after HIV D+R+ kidney transplantation

Results from a secondary analysis of the HOPE in Action KT study (NCT02602262), evaluating post-transplant infections in kidney transplant recipients (KTRs) with human immunodeficiency virus (HIV) receiving kidneys from donors with HIV (HIV D+R+; n = 99) vs those receiving kidneys from donors without HIV (HIV D−R+; n = 99), were published in Clinical Infectious Diseases by Arant et al. The primary outcome was the cumulative incidence of first clinically relevant infection within 24 months post-kidney transplant (KT). 

Key data: At 24 months, the cumulative incidence of first clinically relevant infection was 73.8% with HIV D+R+ KT (95% confidence interval [CI], 63.1–81.2) vs 64.7% with HIV D−R+ KT (95% CI, 53.0–73.4). Time to first clinically relevant infection was shorter with HIV D+R+ KT (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.01–2.04; p = 0.04), while time to first clinically relevant infection requiring hospitalization was similar between groups (aHR, 1.21; 95% CI, 0.78–1.86; p = 0.4). There were no differences in overall infection rates, site, duration, or infection-related mortality between groups. 

Key learning: HIV D+R+ KT was associated with earlier post-transplant infection vs HIV D−R+ KT, but not increased infection severity, supporting its continued use with close early infection monitoring.