Introduction: Transplantation in patients previously infected with HIV is already well established, and cases of donor infection transmission have already been reported. However late acquisition after transplantation is poorly studied.

Objective: To present a case series describing characteristics and outcomes of HIV-infection acquired lately after kidney transplantation.

Results: From 2009 to 2016, seven cases of HIV-infection were diagnosed in kidney transplant patients in follow-up. Five patients were male, with mean age at acquisition was 41 years (min 27, max 52), mean time after transplantation of 8.3 years (5/7 patients after five years of transplantation), mean creatinine at diagnosis 1.8 mg/dL. In all cases, sexual transmission was the only possible acquisition mode. In all four living transplants, HIV-infection was excluded in the donors. The trigger to diagnosis was cytomegalovirus-infection in 3/7 cases, syphilis in one case and high-grade intraepithelial neoplasia in one case. In one case, HIV-testing was sought by the patient. In the last one case, HIV-diagnosis was done during late allograft dysfunction and return to dialysis. In one case there was necessary to withdrawal antiproliferative agent due to leucopenia. In another one case, complete discontinuation of immunosuppression was required due to severe infection. Hospital readmission was required in 3/7 patients (bacterial pneumonia in two cases, acute pyelonephritis and disseminated varicella-zoster in one case). Three patients suffered graft loss due to immunological phenomena (2/3 within two years from the diagnosis of HIV-infection). There was one case of death with functioning graft, due to bacterial pneumonia, five years after diagnosis.

Conclusion: As in general population, sexual acquisition of HIV-infection is an important question also among stable and late kidney transplant recipients. Late onset of viral diseases can be the trigger for diagnosis. It is associated to hospital readimissions, premature graft loss and recipient death.

CITATION INFORMATION: Cristelli M, Ribeiro M, Santos D, Mazolin M, Tedesco-Silva H, Medina-Pestana J. Sexual Acquisition of HIV-Infection After Kidney Transplantation: Late Presentation and Potentially Fatal Complications. Am J Transplant. 2017;17 (suppl 3).

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