{"doi":"10.1093/ckj/sfaf027","title":"Breaking barriers: giving HOPE to people living with HIV and end-stage renal disease","abstract":null,"journal":"Clinical Kidney Journal","year":2025,"id":612410,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1373830,"name":"Adnan Sharif","orcid":"0000-0002-7586-9136","position":1,"is_corresponding":false},{"id":1576807,"name":"Matthias Diebold","orcid":"0000-0002-6914-9132","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Breaking barriers: giving HOPE to people living with HIV and end-stage renal disease","abstract":"Kidney disease affects about one-third of people living with HIV (PLHIV), with 1.5% of dialysis patients in the USA being HIV-positive [1, 2]. Historically, HIV was an absolute contraindication for kidney transplantation, but improved antiretroviral therapies demonstrated transplants from HIV-negative donors improved survival for PLHIV with kidney failure [3]. Nevertheless, organ shortages disproportionately affect PLHIV, especially African Americans, who face health inequalities [4]. After promising results from South Africa, the 2013 HOPE Act permitted kidney transplants from donors with HIV in the USA for recipients with HIV. In their multicenter study, Durand et al. evaluate these outcomes of kidney transplantation from donors without HIV into recipients with HIV [5]. This study included transplant-eligible adult PLHIV with kidney failure who consented to potentially receive a kidney allograft from a donor with HIV. Donors were required to have no active opportunistic infections or cancer, but there were no exclusions based on HIV RNA or CD4+ counts. Group assignment depended on whichever organ was available first. The primary outcome was a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection, whichever occurred first, and was assessed in a non-inferiority time-to-event analysis. Overall, 99 recipients of kidneys from donors with HIV were compared with 99 recipients of kidneys from donors without HIV. The donor groups were similar, except donors with HIV were more often Black, had lower Kidney Donor Profile Index scores, and were more frequently seropositive for hepatitis B and cytomegalovirus. After a median follow-up time of 2.2 years, the hazard ratio of the primary composite endpoint was 1.00 (95% confidence interval 0.73–1.38), indicating non-inferiority. Overall patients’ survival, graft loss, and rejection rates were similar in both groups. Adverse events, infections, surgical or vascular complications and cancer did not significantly differ between groups. Breakthrough HIV infections were low in both groups; however, they were more common in recipients from HIV-positive donors. This was often due to non-adherence to antiretroviral therapy, but all patients regained viral suppression afterward. A single case of potential HIV superinfection occurred without clinical consequences Fig. 1. Visual Abstract of the study. Created in https://BioRender.com The authors demonstrated that in PLHIV, kidney transplantation from donors with HIV is non-inferior to transplantation from donors without HIV. These findings can potentially facilitate ∼500–600 additional transplants for transplant candidates with HIV using organs from donors with HIV [6]. One limitation is that, while true randomization was not possible due to organ allocation constraints, groups were pseudorandomized by organ availability. Awareness of donor HIV status will likely influence allocation and utilization, but these results should reassure the transplant community about the use of organs from donors with HIV. In fact, mavericks may even speculate why not use organs from donors with HIV for transplant candidates without HIV who have an urgent need for transplantation. It is impressive and commendable that the same research group has worked for years to identify the problem from registry studies, travel to South Africa to learn about the first experience, evaluate potential benefit of a policy change, implement the HOPE act in 2013, and investigate the benefit in a large nationwide study. This highlights the role of pioneers in medicine who challenge common practices and pursue the goals of improvement, fairness, and equality—an inspiration for future generation of transplant professionals. The authors declare no conflicts of interest.","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"39995808","pmcid":"PMC11848131","openalex_id":"https://openalex.org/W4406891452","authors":[],"funders":[],"total_grants":0,"fwci":0.7966,"citation_percentile":0.64883787,"influential_citations":0,"citation_trend":[{"year":2025,"count":1}],"oa_status":"gold","license":"cc-by-nc","oa_locations":[{"url":"https://doi.org/10.1093/ckj/sfaf027","host_type":"journal"},{"url":"https://doi.org/10.1093/ckj/sfaf027","host_type":"publisher"},{"url":"https://academic.oup.com/ckj/advance-article-pdf/doi/10.1093/ckj/sfaf027/61664748/sfaf027.pdf","host_type":"publisher"},{"url":"https://academic.oup.com/ckj/article-pdf/18/2/sfaf027/61664748/sfaf027.pdf","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/39995808","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11848131","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC11848131/pdf/sfaf027.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11848131","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11848131?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["HIV/AIDS Research and Interventions","HIV, Drug Use, Sexual Risk","HIV-related health complications and treatments"],"mesh_terms":[],"keywords":["End stage renal disease","Human immunodeficiency virus (HIV)","Disease","Medicine","Stage (stratigraphy)","Intensive care medicine","Gerontology","Psychology","Virology","Internal medicine","Biology"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T03:17:10.216002Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}