*Purpose: Pneumocystis jiroveci pneumonia (PJP) prophylaxis is recommended for all kidney transplant recipients (KTR) for after transplant. HIV-positive KTRs represent a unique subset, and there is no definite clinical data on the duration of PJP prophylaxis recommendation. Duration of prophylaxis vary with institutions, from 6 months to life-long post solid-organ transplant in HIV-positive recipients. The objective of this study is to determine the incidence of PJP infection in HIV-positive KTRs who received 6 months of PJP prophylaxis.

*Methods: We performed a retrospective observational study on all HIV-positive KTRs at Hahnemann University Hospital from 2001 to 2017 to determine the incidence of PJP by the end of follow-up. Based on our institution’s protocol, all patients received a six-month PJP prophylaxis.

*Results: We identified 122 HIV-positive KTRs in the 16-year period. Eighty-two percent were male (n=101) and 83% were African American (n=102). The mean age at transplant was 48 ± 9 years. High rate of HCV coinfection was observed (37%, n=45). Eighty-nine percent of kidneys were from deceased donors (n=109); none of the donors were HIV positive. Mean pre-transplant CD4 count of KTRs was 461 ± 127 cells/µL. Majority received induction therapy with basiliximab with or without intravenous immunoglobulin, while one patient received antithymocyte globulin induction. Maintenance immunosuppression was with a calcineurin-inhibitor (tacrolimus or cyclosporine) an anti-proliferative agent (mycophenolate or sirolimus), with a steroid tapering regimen. In addition to PJP prophylaxis, all patients also received cytomegalovirus prophylaxis for 6 months. None of the 122 HIV-positive KTRs in the study developed PCP post-transplant after a mean follow-up of ~3 years (median allograft follow-up 1051 days (IQR 424-1779). Median CD4 counts post-transplant was 394 cells/mL (IQR 239-584). Majority of patients received TMP/SMX, while a minority of patients received other medications for prophylaxis secondary to allergies.

*Conclusions: Most observational studies on solid organ transplant (liver and kidney) in HIV-positive transplant recipients employ a life-long regimen of PJP prophylaxis. However, with 6 months of PJP prophylaxis, we report none of our 122 KTR patients developed PJP post-transplant with a median follow-up of 3 years. This suggests that a six-month regimen may be sufficient for HIV-positive KTRs,, similar to recommendations for non-HIV KTRs.

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