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Transient Loss of HIV-1 DNA in an HIV-1 Positive Patient After Kidney Transplantation: A Case Report

Transient loss of HIV DNA after ATG therapy for kidney transplantation. CD4 T-cell count (blue, left axis) and CD4 T-cell percentage of all T cells (orange, right axis) were quantified, and qualitative HIV DNA measured in the peritransplant period.

Solid organ transplantation is increasingly used in human immunodeficiency virus (HIV) patients and is accumulating favorable outcomes from kidney and liver transplants in HIV-1 positive patients.1, 2

Antithymocyte globulin (ATG) is used for prevention and treatment of acute rejection following renal transplantation.3 It promotes T-cell depletion as well as modulation of cell surface antigens.4 It is possible that this agent may indirectly target and reduce the latent HIV-1 reservoir5 and reactivate the latent reservoir.6

Here, we report a case of an HIV-1 positive patient who demonstrated a transient clearance of the proviral DNA after receiving ATG as induction immunosuppression post kidney transplant.

Case Report

A 53-year-old man with end-stage renal disease was referred to our institution for kidney transplant evaluation. He was diagnosed with HIV-1 infection 12 years prior with a CD4 T-cell count above 450 cells/ mcl and undetectable HIV-1 viral load for more than 6 years on zidovudine, abacavir, and efavirenz therapy.

The patient underwent deceased donor kidney transplantation. Induction immunosuppression with ATG was used given concern for increased allograft rejection risk due to underlying HIV infection. He also received corticosteroids, mycophenolate, and tacrolimus through the peri- and posttransplant period. Antiretroviral therapy was continued, and the regimen was intensified with raltegravir, which has been shown to reduce HIV-1 reservoir size in some7, 8 but not all trials.9, 10

HIV-1 proviral DNA was measured serially in whole blood pre- and posttransplant using the Amplicor HIV-1 DNA Test, version 1.5 (Roche Molecular Systems Inc., Branchburg, NJ). In addition, the CD4 T-cell count and plasma HIV-1 RNA viral load were obtained (Figure 1).

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-Ana C. Paim, MD, Stacey A. Rizza, MD, Andrew D. Badley, MD, Mikel Prieto, MD, Sandra J. Taler, MD, Pearlie P. Chong, MD, MSCR, Nathan W. Cummins, MD

This article originally appeared in the October issue of The American Journal of Medicine.

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