NEJM：艾滋病患者间可进行肾移植

2015-02-15 王英生物通

来自南非的一项新研究表明，HIV可能并不是艾滋病毒感染者之间进行肾脏移植的一个障碍。相关研究结果发表在2月12日的《新英格兰医学杂志》(New England Journal of Medicine)。对于担心接受其他艾滋病毒感染者肾脏移植的HIV阳性患者来说，这是个好消息。延伸阅读：科学家发现艾滋病治疗的一个有用靶标。专家称，该研究似乎不会对美国产生直接的影响，在那里HIV感染并

来自南非的一项新研究表明，HIV可能并不是艾滋病毒感染者之间进行肾脏移植的一个障碍。相关研究结果发表在2月12日的《新英格兰医学杂志》(New England Journal of Medicine)。

对于担心接受其他艾滋病毒感染者肾脏移植的HIV阳性患者来说，这是个好消息。延伸阅读：科学家发现艾滋病治疗的一个有用靶标。

专家称，该研究似乎不会对美国产生直接的影响，在那里HIV感染并不常见，肾脏疾病往往靠透析而不是移植进行治疗。

本文作者、南非开普敦Groote Schuur医院移植术主任Elmi Muller博士称：“但在南非，使用HIV阳性供体可能会解决我们都在经历的一些问题，获得足够的供体来挽救终末期肾脏疾病患者。”

跟世界其他地方一样，在南非，HIV和AIDS治疗的变革正在延长艾滋病感染者的寿命。但是根据这项研究的背景介绍，许多艾滋病感染者会继续发展肾脏疾病。

哈佛大学免疫学和传染病教授Eric Rubin博士表示：“HIV可对肾脏产生直接的影响，一种称为HIV肾病变的综合征，这会导致肾衰竭。”

Rubin在这项研究之后共同撰写了一篇评论，他补充说：“HIV患者易受肾衰竭其他常见因素的影响，最显著的是高血压。”

在南非，大约8%到22%的服药HIV患者出现肾脏疾病，在未接受治疗的HIV患者中这个比例更高(估计在20%到27%之间)。

治疗肾脏疾病的方法之一就是肾脏移植，但是人们一直质疑，当供体(活体或脑死亡)也感染HIV时，这是否还是一个好办法。Muller解释说，人们一直担忧，是否捐献的肾脏会带有第二株HIV，从而使患者病情加重。另一株病毒也可能比受者现有病毒株更加耐药，这可能使患者治疗更加艰难。

在新的研究中，27名具有肾脏疾病的HIV阳性患者，接受了来自已故HIV阳性患者的肾脏移植。他们都服用了HIV药物。研究报道称，患者进展情况良好——评论称该结果令人印象深刻，在五年后有74%的人仍然活着。然而，Muller说他们的身体更可能会排斥供体肾脏。

Rubin说：“这些结果对美国的影响较小，这里HIV感染较少，死于HIV的人也较少，这意味着尸体将不太可能被艾滋病毒感染。同时，他说，在美国更为普遍的是用透析治疗肾脏疾病，而在南非等国家的患者可能别无选择只能接受肾脏移植。

虽然本研究中所有供肾者已经死亡，但仍然存在的问题是：HIV患者应该考虑在活着的时候捐赠肾脏?

这项研究伴随评论的共同作者Julie Ingelfinger博士却不这么想。她是New England Journal of Medicine 副主编和哈佛医学院儿科教授。她说：“目前，有明确的原因可解释为什么不考虑使用HIV阳性患者作为供体。一个原因就是，与大多数人相比，这样的人患上肾脏疾病的风险更高。”

原始出处：

Muller E1, Barday Z, Mendelson M, Kahn D.HIV-positive-to-HIV-positive kidney transplantation--results at 3 to 5 years.N Engl J Med. 2015 Feb 12;372(7):613-20. doi: 10.1056/NEJMoa1408896.

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2015-12-09 10518093zz

#艾滋病患者#

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2015-07-29 sundong

那么免疫抑制剂怎么使用呢

150 0
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2015-04-11 x35042875

轻度肾脏疾病对母亲和婴儿可能会增加孕期风险

147 0
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2015-03-05 lovetcm

太罕见了

144 0
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2015-03-02 xiaoai5777

好文章，超赞

148 0
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2015-02-16 Johnny1989

已阅

198 0
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2015-02-16 Johnny1989

谢谢分享！

155 0
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2015-02-16 windmilL1989

以阅

20 0
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2015-02-15 午夜星河

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