Stock Roland, Carlson Freise,
Hirose Terrault

ABSTRACT

Kidney transplantation remains the preferred treatment for individuals with end-stage kidney disease, yet organ shortages continue to limit timely access to transplantation worldwide. For people living with HIV, advances in combination antiretroviral therapy have transformed HIV infection into a manageable chronic condition, allowing transplantation to become a safe and effective therapeutic option. The use of kidneys from HIV-positive donors for HIV-positive recipients has emerged as a promising strategy to expand the donor pool while maintaining favorable clinical outcomes. Early clinical studies and national transplant programs have demonstrated encouraging results, including acceptable graft survival, patient survival, and manageable rates of opportunistic infections when recipients are carefully selected and monitored. Nevertheless, broader implementation requires addressing several unresolved issues, including donor eligibility criteria, viral strain compatibility, antiretroviral drug interactions with immunosuppressive agents, long-term graft function, and the potential emergence of drug-resistant viral variants. Ethical considerations, informed consent,