Belatacept shows benefits for kidney transplant recipients with HIV
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For kidney transplant recipients who were HIV positive, switching from calcineurin inhibitors to belatacept conferred a variety of benefits, including improved allograft function, according to a study from France.
“Kidney allograft survival in [HIV]-positive patients is lower than that in the general population,” Karim El Sakhawi, MD, of Groupe Hospitalier Henri-Mondor/Albert-Chenevier, and colleagues wrote. “Belatacept increases long-term patient and allograft survival rates when compared with calcineurin inhibitors (CNIs). Its use in HIV-positive recipients remains poorly documented.”
To shed light on this topic, researchers conducted a retrospective multicenter study of 12 HIV-positive kidney transplant recipients who switched from CNI to belatacept between June 2012 and December 2018 (mean time of switch after transplant was 10 months). They compared outcomes between this cohort and a control cohort treated with CNI.
Results showed that, 1 year after the initiation of belatacept therapy, patient and allograft survival rates were 92%.
In addition, kidney allograft function significantly increased during the span of 12 months and HLA donor-specific antibodies remained stable.
“We ... demonstrated the safety of belatacept conversion in HIV-positive recipients with satisfactory patient survival and significant increase of allograft function after the switch,” El Sakhawi and colleagues wrote of the findings. “In addition, we did not observe major adverse effects over the 1 year of treatment. HIV infection remained under control without viral load rebound despite non-adherence to [antiretroviral] ARV therapy in two cases. CD4þ and CD8þ T-cell counts remained stable for 12 months after conversion.
When compared with the control group, our results suggest that belatacept is a safe alternative to CNI in terms of acute rejection, survival and HIV disease control.”
According to the researchers, a larger cohort should be evaluated to confirm the findings.
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