Patients With Human Immunodeficiency Virus Disease Should Have Equal Access to Kidney Transplantaion.

Running Head : HIV AND TRANSPLANTATION

HIV Patients Should Have Equal Access to Kidney Transplantation

[Name]

[University]

Abstract

With the improvements in technology , kidney transplantation may now be pursued by patients with Human Immunodeficiency Virus infection although various transplant centers are reluctant to carry out the procedure due to multitude of medical and ethical issues . HIV is a potent disease with a high morbidity and mortality rate . HIV-infected patients may develop associated nephropathies progressing to End Stage Renal Disease . There are two options to cure absolute renal function chronic

dialysis therapy and kidney transplantation

Introduction

HIV infection may be obtained by patients receiving renal replacement therapy (RRT ) through blood transfusions , renal allograft , sexual contacts , or needle sharing of drug addicts . Viral infection or HIV-associated nephropathy can cause renal failure . In the early 1980 's prognosis of patients with the acquired immunodeficiency syndrome (AIDS was very low , and survival rate of HIV-infected individuals with ESRD was miserable . Accordingly , several people even doubted the worth of providing continuance dialysis to patients with AIDS . Due to progress in diagnostic techniques in serologic and viral markers of disease , and use of extremely efficient antiretroviral agents , the prognosis of HIV-positive individuals has radically improved . Today , skills and knowledge in hemodialysis are effective modes of therapy and many centers , though some are reluctant , are now starting to practice renal transplantation in HIV-infected patients

Human Immunodeficiency Virus

HIV infects CD4 T cells , making the immune system weak as these cells malfunctions . Abnormal activation ofCD8 T cells may contribute to the loss of both CD4 AND CD8 T cells through apoptosis , which may represent a major cause of infected and non-infected cell death in HIV infection . Many HIV-infected individuals proliferative responses to recall antigens , irradiated stimulator peripheral blood mononuclear cells from healthy , unrelated donors , or T cell mitogens (Roland Stock , 2003

HIV infection can worsen existing renal disease and can trigger pathologically distinct disease named HIV-associated nephropathy (HIVAN , a focal segmental glomerulosclerosis (FSGS ) associated with severe cystic tubular lesions , leading to chronic renal failure . Renal syndromes include : fluid and electrolyte malfunction , proteinuria nephrotic disease , progressive azotemia , inflamed kidneys , and fast succession to end stage renal disease (ESRD . HIV-infected patients who developed renal disease have short survival span

Transplantation process may increase the risk of HIV-infected patients in accelerating the depletion and dysfunction of their CD4 T cells which may further result in the development of more serious and complicated disease , such as AIDS , making HIV replication harder to control . On the other hand , immunosuppression might reverse the immuno-pathology associated with HIV disease (Roland Stock , 2003

End Stage Renal Disease

When the kidney circulatory system , renal failure finally meet the end stage renal disease or ESRD , the final stage of nephropathy or the premeditated degeneration of the kidneys . In 1998 , over eighty-six thousand patients received therapy for treating ESRD in the United States . Autonomously Medicare expenditures rose to 12 .9 billion dollars from 12 billion in 1998 . The and is now projected to be 28 .3 billion dollars by 2010...