HIV Patients Now Have the Option of Organ Transplants

Only recently has organ transplantation, specifically liver and kidney, been considered an option for HIV-infected individuals. A Sept. 15 press release states that new developments and clinical approaches have resulted in good outcomes in an increasing number of transplanted HIV-positive patients. Further, there is no indication that HIV-positive patients are at an increased risk to progress to AIDS.

As HIV-infected and AIDS patients are living longer - said to be the result of anti-HIV drug combinations - other complications have come to the forefront. Many patients are now experiencing kidney and liver disease related to both hepatitis B and C. Reportedly, the anti-HIV drug combinations can exacerbate the damage to the liver because of their toxic effects.

The anti-HIV drug combinations, known as "highly active aniretroviral therapy" (HAART), have no doubt given many people infected with HIV a new lease on life. But there have also been some long-term problems, experts says.

According to the Alberta Reappraising Aids Society (ARAS), HAART therapy is prescribed to many HIV-positive people, even before they develop symptoms of AIDS, even though the "list of side effects...is so long that it is impossible to categorize all of them." The ARAS quotes from a Feb. 2006 study (Wyatt CM et al. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS. 2006 Feb 28;20(4):561-5) that says "kidney disease has emerged as a leading cause of death among HIV-infected patients in the HAART era...In addition, chronic kidney disease and acute or chronic liver disease were strongly associated with both acute renal failure and in-hospital mortality among patients with HIV, suggesting a need for more aggressive management of chronic kidney disease and hepatitis virus co-infection in the setting of HIV."

Dr. Michelle E. Roland, Assistant Professor of Clinical Medicine at the University of Calif., San Francisco (UCSF), specializes in antiretroviral drug resistance and organ transplantation in HIV-infected patients. She and Dr. Peter G. Stock, Professor of Surgery in Residence at UCSF, wrote that the "blanket exclusion (for organ transplantation) of HIV-infected patients can no longer be justified based on the early results demonstrating the safety and efficacy of transplantation in this group of patients."

The doctors report that progress has been made in several areas, according to studies at UCSF and elsewhere. The ability to control HIV infection using HAART and improvement in preventing other infections have made liver and kidney transplants an increasingly viable option for HIV-positive individuals. For example, their study of the 3-year survival rate for HIV-positive liver transplant patients was 73 percent, which is similar to patients not infected with HIV.

Although Drs. Stock and Roland say more research is still needed, there is no evidence thus far to suggest that the risk of progression to AIDS is increased in HIV-positive patients who undergo organ transplantation. Therefore, it's "imperative that HIV-positive patients, HIV health care providers, and the transplant community are aware that transplant is a viable option for the HIV infected patient," the doctors conclude.

A summary of the newest organ transplant developments for HIV-infected individuals can be found in the Sept. 15 issue of the "Transplantation" journal.

Sources:

Press release, Transplants for HIV-Positive Patients?; http://www.newswise.com/articles/view/532923/

ARAS; http://www.aras.ab.ca/haart.html