Immunosuppressive therapy in HIV-infected patients undergoing kidney transplantation: a meta-analysis of case series studies

Abstract

Chronic kidney disease (CKD) prevalence ranges from 7.2% to 32.6% in people living with HIV/AIDS (PLHA). The specific risk factors for CKD in PLHA are being black, presence of proteinuria, family history of kidney disease, high viral load, low CD4 + lymphocyte count, diabetes and high blood pressure. Old age, smoking, chronic infection and obesity, found in people not infected with HIV, are also considered. Three situations are the main: HIV nephropathy (and other associated glomerulopathies), nephrotoxicity due to drugs and procedures, and CKD caused or worsened by comorbidities. Until about a decade ago, HIV infection was absolute contraindication to organ transplantation. Recent studies suggest that kidney transplantation (KTx) is feasible in properly selected PLHA. Although very effective, the KTxs in PLHA present major difficulties. Most studies report higher incidences of acute rejection, reaching more than 50%. Immunological and pharmacological factors have great influence. Current literature shows that the best immunosuppressive regimen for KTxs in PLHA has not been identified. Therefore, due to the relevance of the subject and the absence of RCTs, the objective of the study will be to identify, through a proportional meta-analysis of case series, the most effective and safe immunosuppressive regimens in PLHA undergoing KTx. Case series studies will be included since they have evaluated any immunosuppression regimen used in PLHA undergoing KTx. We will consider HIV-infected patients undergoing KTx of both sexes, without limitation due to race or age. The outcomes will be mortality, graft survival, episodes of acute and chronic rejection, general infectious complications, non-infectious complications, and clinical and laboratory course of HIV infection. Studies will be obtained from the following sources: MEDLINE (1966 to present), EMBASE (1980 to present) e LILACS (1982 to present). Two reviewers will independently screen the titles identified by the literature search. A standard form will be used to extract relevant information from the studies. Proportional meta-analysis of case series will be conducted comparing the occurrence of outcomes in different immunosuppressive regimens through StatsDirect software. Subgroup analyzes will be performed whenever possible. Funnel plots will be performed to assess the possibility of publications bias.