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Sexual acquisition of HIV infection after solid organ transplantation: late presentation and potentially fatal complications.

Sexual acquisition of HIV infection after solid organ transplantation: late presentation and potentially fatal complications.
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Cristelli MP, Mazolin MA, Manzardo C, Ribeiro MSJ, Cofán F, Santos DWC, Castel MA, Tedesco-Silva H, Moreno A, Diekman F, Miro JM, Medina-Pestana JO,


Cristelli MP, Mazolin MA, Manzardo C, Ribeiro MSJ, Cofán F, Santos DWC, Castel MA, Tedesco-Silva H, Moreno A, Diekman F, Miro JM, Medina-Pestana JO, (click to view)

Cristelli MP, Mazolin MA, Manzardo C, Ribeiro MSJ, Cofán F, Santos DWC, Castel MA, Tedesco-Silva H, Moreno A, Diekman F, Miro JM, Medina-Pestana JO,

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Transplant infectious disease : an official journal of the Transplantation Society 2018 03 30() e12894 doi 10.1111/tid.12894

Abstract
INTRODUCTION
While the growing knowledge on HIV among solid organ transplant recipients (SOT) is limited to either pretransplant infection or allograft transmission, there are only sparse reports describing HIV-infection after transplantation through sexual route, the primary mode of transmission in the general population.

METHODS
From two different centers, we report nine new cases of HIV infection in SOT recipients attributed to sexual acquisition: eight cases of kidney-transplant recipients and one heart-transplant recipient.

FINDINGS
There were nine cases of post-transplant HIV-infection detected among 14,526 transplants performed 1998 to 2015. In 6/9 cases, infection was contracted five years after SOT. All but one patient had stable allograft function under immunosuppressive therapy. The main trigger to diagnosis was late CMV disease and sexually transmitted diseases; five patients had CDC-stage 3 HIV infection. In 7/9 patients, virologic response and CD4 recovery were achieved within three months after starting antiretroviral therapy (ART). After an average of 3.6 years post diagnosis, 5/9 patients remained alive with well-controlled infection and functioning allograft.

CONCLUSION
Sexual acquisition of HIV infection after SOT represents a difficult challenge, as it may occur in any kind of transplant and at any time. The course of infection resembles that of the general population, with life-threatening infectious complications, but good response to ART. Assessment of lifestyle and risk behavior is paramount, as indications may be not disclosed without direct questioning. This article is protected by copyright. All rights reserved.

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