Physicians face a tough choice when treating people infected with the human immunodeficiency virus who also have organ failure. Because of the poor long-term prognosis for these patients as well as the potential danger of mixing anti-AIDS drugs with the immune suppressants needed after transplants, physicians have traditionally been wary of transplants in this group.
Two small studies now describe several successful organ transplants in HIV-infected people. The early findings have spurred researchers to collect more data to clarify whether excluding such patients from transplant lists is appropriate.
Parthi Srinivasan of King’s College Hospital in London reports on seven HIV-positive people who received liver transplants there in the past few years. Four had severe hepatitis C infections and died between 3 and 25 months after their transplant. Three other transplant patients with hepatitis B, which is less deadly, remain alive at 3, 13, and 33 months after the transplant.
In the other study, researchers at the University of California, San Francisco report that six HIV-infected patients have received transplanted organs. Internist Michelle E. Roland says that five people who received kidney transplants have so far survived from 2 to 10 months. Four of these people are in good health; physicians are treating the fifth for organ rejection. One hepatitis C patient who received a liver is alive, albeit with complications, nearly 11 months after surgery.
None of the San Francisco HIV patients had AIDS at the time of the transplant. As measured by a healthy concentration of immunity-boosting CD4 T cells in their blood, none has it now.
Roland and her colleagues are watching closely for any interaction between the anti-HIV drugs and immune-suppression medication. T cell counts in the patients fell at the time of their transplants but rebounded afterward. Blood-concentrations of HIV have stayed at manageable levels, particularly in the four healthiest patients, Roland says.
Based on these studies, the prospects for HIV-positive transplant candidates should be reevaluated, Roland says. “Poor life expectancy is no longer a rational argument” for denying a person a transplant in countries where the best drug combinations are available, she says.