Decrease the rejection rates include the utilization of antiviral regimens which do not impact the cytochrome p450 system to avoid the drug to drug interactions between immunosuppression and antiretroviral agents. An interesting strategy currently being tested in a clinical trial will determine the impact of CCR5 blockade in blocking the immune response and decreasing HIV persistence. Other interesting and unexpected findings include the impact of TOR inhibitor on depleting HIV persistence in the CD4+ lymphocytes. Serendipitous events in our initial trials have revealed immunosuppressive agents with anti-retroviral qualities (sirolimus/TOR inhibitor), and antiretroviral agents (CCR5 blockade/maraviroc) that have immunosuppressive qualities. Finally, opportunistic infections have not been problematic in the HIV infected recipients. HHV8 mediated Kaposi’s sarcoma can be controlled with rapamycin. However, HPV mediated anal/cervical cancers may be problematic, and will require rigorous monitoring following transplantation.