Organ transplants for AIDS patients becoming more common; reflects better prognosis for the once deadly disease.
Transplants in HIV patients became feasible with the discovery of a new class of AIDS drugs called protease inhibitors. Cocktails of these drugs, termed Highly Active Antiretroviral Therapy, or HAART, successfully block HIV replication long-term. As a result, the greatest health threat AIDS patients face today is not the infections that proved so lethal early in the epidemic but organ failure due to diabetes, hepatitis, and other diseases.
"HIV has been impacting the medical system for 25 years now, and it's not the disease it used to be," said Jeff Getty, an AIDS patient from California who made medical history when he was given a bone marrow transplant from a baboon. "The reality today is that you're going to live long enough so that something other than HIV is going to kill you."
Early results of transplants in HIV patients have been largely favorable. One study, released 3 months ago, followed 24 HIV-positive patients who received liver transplants. One year after getting their new organs, 87% are still alive-a figure nearly identical to survival rates in uninfected patients. Importantly, there was no evidence that the profound immunosuppressive therapy needed to prevent organ rejection allowed unfettered replication of the AIDS virus and hastened death. The results for kidney transplant results are less encouraging, with University of California San Francisco researchers reporting that 5 of 10 HIV patients who underwent renal transplantation experienced significant rejection episodes-far higher than usual. While the reasons are unclear, doctors speculate that their reluctance to use high doses of antirejection drugs in patients whose immune systems were already threatened by HIV was a contributing factor.
About 100 transplants in HIV patients have been done to date, and insurers are increasingly willing to cover the costs. Not every surgeon or insurance company is ready to sign on, however, and the result has been some contentious, high-profile court battles. In 2002, a Boston insurance company initially refused to pay for a liver transplant for Belynda Dunn, an HIV-infected woman with hepatitis C. Her case drew the attention and fury of Mayor Thomas Menino, who started a campaign that raised $275,000 for the surgery, including, ultimately, $100,000 from Dunn's insurer. She underwent 2 transplants at the University of Pittsburgh but died after the second operation. As recently as last December, a judge ordered the Pennsylvania Medicaid program to pay for a new liver for an HIV-positive man.
To forge a consensus, the National Institute of Allergy and Infectious Diseases (NIAID) has launched a 5-year, $17 million study to examine the safety and outcomes of organ transplants in HIV-positive people. Seventeen transplant centers are participating in the study, and last month, federal regulators authorized Boston's Beth Israel Deaconess Medical Center MA to begin enrolling patients. Beyond seeking to prolong and improve the lives of 275 men and women, the researchers must determine if the outcomes justify the use of donated organs-a scarce commodity-in this patient population.
"It's such backward thinking for people to argue that HIV patients shouldn't be transplanted," said John Fung, MD, chief of transplant surgery at the University of Pittsburgh, which has performed more than 30 such operations-more than any other hospital. Fung's opinion is shared by Miguel Salvador, 47, a music professor in Miami (FL). In 1999, though Salvador's HIV infection was in check, he was near death from hepatitis B. Studies show that about 10% of HIV patients have hepatitis B, and up to one-third have hepatitis C.
"I really went through some very bad times with hepatitis," Salvador said. "But once I went through the transplant, it was all history. It was like receiving a new life."
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|Date:||Mar 29, 2004|
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