Cardiothoracic transplantation for patients with HIV, and hepatitis B and C remains a controversial topic. Historically, infection with any of these viruses was considered a relative or even absolute contraindication for transplantation. However, favorable experience in liver and kidney recipients has led some programs to progressively adjust selection criteria. The recent ISHLT listing criteria guidelines now include HIV, HCV and HBV positive patients and more programs are performing transplantation in these complex populations. Having a current understanding of these diseases, therapy and monitoring will assist the transplant team. This includes knowledge of drug interactions and the concerns for the various types of immunosuppression (Induction, maintenance) on these patients and if there are preferred agents to use. Lastly developing an approach with an understanding of how to manage complications is necessary for success. Therefore, the focus of this symposium is to increase the knowledge of the CT transplant community about the management and pharmacological treatment options for CT transplants candidates with HIV, hepatitis B or C, before and after transplant.