Kidney transplant (KT) is now a viable option for select HIV+ end-stage renal disease (ESRD) patients. As OPTN does not collect HIV status at waitlisting, no study has examined the epidemiology of HIV+ candidates awaiting KT. IMS pharmacy fills (1/1/01-10/1/12) were linked with SRTR data. IMS Health pharmacy data include roughly 75% of medication fills in the US. KT candidates who filled >1 antiretroviral medication unique to HIV treatment were identified (n=938); 94% had >1 HIV+ medication fill. Simultaneous listings were collapsed and HIV+ waitlist candidates were linked to US census data. Rural/urban setting was defined by Rural Urban Commuting Area zip codes. Geographic differences in descriptive characteristics were compared across UNOS-defined regions and in rural vs. urban settings. Of HIV+ KT waitlist candidates, 65.3% were aged < 50 years; more than two-thirds were male (77.7%) and African American (71.4%). Hypertension was the most common cause of renal failure (32.6%), then HIV-associated nephropathy (21.7%) (Table). Number of HIV+ waitlist candidates varied significantly by region. Most candidates were from urban settings; three regions have never listed an HIV+ candidate living in a rural setting (Figure). Most HIV+ waitlist candidates were young African American males. At least one HIV+ candidate was listed for KT in all 11 UNOS regions. Most candidates were from urban settings, and three regions have never listed an HIV+ candidate from a rural setting, yet 8% of HIV+ patients in the US live in rural settings. These findings suggest possible geographic disparities in access to KT among rural HIV+ ESRD patients.

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