Purpose of Review: The goal of this review is to synthesize recent evidence on solid organ transplantation (SOT) in people with HIV (PWH), highlight remaining clinical uncertainties, and outline policy and practice implications.

Recent Findings: Advances in HIV, hepatitis C, and transplant immunosuppression have improved SOT outcomes in PWH. Risk of rejection, though substantially reduced, may remain higher than that of recipients without HIV. Access to transplant has improved with the new practice of transplantation from donors with HIV to recipients with HIV (HIV D+/R+), with noninferior outcomes for HIV D+/R+ kidney transplantation, promising outcomes for HIV D+/R+ liver, and first transplants reported in HIV D+/R+ heart transplantation.

Summary: Modern data support SOT for PWH as safe and effective. Future priorities include defining mechanisms of rejection, better characterizing risks and long-term outcomes of HIV D+/R+ transplantation, with the potential role of transplantation from donors with HIV to recipients without HIV on the horizon.