*Purpose: Human immunodeficiency virus (HIV) seropositivity is generally considered a contraindication to lung transplantation (LTx). HIV-infected adults are at higher risk of developing chronic lung diseases, yet there is limited experience with LTx in these patients. We present two cases of successful LTx in HIV-seropositive adults with fair allograft outcomes.

*Methods: Our LTx database was queried for HIV seropositive patients undergoing LTx between 2007 and 2019. Pre-LTx recipient demographics, trajectory of their intra- and post-LTx course, and HIV disease course were reviewed.

*Results: A 62-year-old man with advanced chronic obstructive pulmonary disease (COPD), hypercapnic hypoxic respiratory failure, and longstanding HIV infection (40 years) was evaluated for LTx. His combination antiretroviral therapy included raltegravir, tenofovir, alafenamide, and emtricitabine; his viral load was undetectable, and CD4 count was 795/mm³ at the time of LTx. He had never had a CD4 nadir <200/mm³ or any opportunistic infections. His intraoperative and immediate post-operative course was uneventful except for an episode of supraventricular tachycardia. He was discharged after LTx on hospital day 14 and he is doing well four months post-LTx. Our second case was a 32-year-old man diagnosed with acquired immune deficiency syndrome at age 30 when he was hospitalized with Pneumocystis carinii (PCP) pneumonia. His highest viral load was 1,533,720 copies/ml, and CD4 nadir was 34/mm³. His other pre-LTx opportunistic infections included cytomegalovirus pneumonitis and secondary syphilis. He subsequently developed interstitial lung disease and fibroproliferative acute respiratory distress syndrome requiring LTx. His combination antiretroviral therapy included abacavir, dolutegravir, and lamivudine. His viral load was 60 copies/ml and his CD4 count was 266/mm³ at the time of LTx. He underwent bilateral sequential LTx on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Intraoperative course was complicated by difficult dissection due to adhesions and elevated pulmonary artery pressures requiring VA-ECMO. His post-LTx course was complicated by multi-drug resistant Pseudomonas infection. He is doing well fifteen months post-LTx.

*Conclusions: LTx is feasible and safe in HIV+ patients with end-stage lung disease who are on a stable antiviral regimen with low viral load. Careful patient selection is necessary with close monitoring of drug regimen post-transplant. Caution with drug interactions in lung transplanted HIV+ patients is warranted.

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