Incidence of BK Virus in HIV-positive Kidney Transplant Recipients: Case Series From South Africa.

Background: BK virus-associated nephropathy (BKVN) is a viral complication after kidney transplantation and an important cause of graft dysfunction and loss. Its impact on HIV-positive kidney transplant recipients (KTRs), who are at increased risk for opportunistic infections, remains poorly understood. Methods: This single-center case series in South Africa describes BKVN incidence and outcomes in HIV-positive KTRs who received kidneys from HIV-positive donors between 2008 and 2025. A screening protocol and schedule were implemented in 2021, and BKVN was classified as possible, probable, or presumptive according to The Second International Consensus Guidelines. Results: Over the study period, there were 63 KTRs and 34 donors; 2 recipients with primary graft failure were excluded. The remaining 61 recipients had a median age of 40 y, 54% were male, and 93% were of Black African ethnicity. Median CD4 count at transplantation was 439 cells/mm Conclusions: Despite limited resources and delayed routine screening, the BKVN incidence was low (5%), and most affected recipients achieved viral control and preserved graft function.