and may increase the activity and toxicity of didanosine (ddI), tenofovir (TDF), and abacavir (ABC). Careful monitoring of both the immunosuppressive drugs and the antiretroviral drugs are required to prevent harmful dysregulation of the immune system that could result in under-immunosuppression, with the resulting risk of rejection, over- immunosuppression, with the resulting risk of opportunistic infections, or loss of HIV viral suppression, with the risk of progression of disease. Most transplant centers have a specific subset of infectious disease physicians who manage patients post-transplant, and are intimately involved in the evaluation and post-transplant processes. As HIV therapy has improved, kidney
transplantation has become a feasible option for many patients who have histori- cally been denied access to transplant. As kidney transplant results in improved survival and improved quality-of-life when compared to dialysis, the option of kidney transplant has become an important addition to patients with HIV-associated nephropathy. Dr. Kenneth Woodside is an Assistant
Professor of Surgery at Case Western Reserve University and Surgical Director of the Program for Renal Transplantation in HIV Patients at the Transplant Institute of the University Hospitals Case Medical Center. Dr. Joshua Augustine is an Associate
Professor of Surgery at Case Western Reserve University and Medical Director of the Program for Renal Transplantation in HIV Patients at the Transplant Institute of the University Hospitals Case Medical Center. ■
SEPTEMBER-OCTOBER 2012 ■ MDNEWS.COM ■ MD NEWS Cleveland-Akron-Canton | 25
