HIV Organ Transplants

With advancements in HIV care, transplantation enters HIV care

Transplant. Getty

Yes, they can.

Persons living with HIV can become organ donors. They can also receive transplanted organs if needed. Organs from HIV positive donors have been used in transplants in HIV positive patients.

Treatment for HIV has advanced to make well-controlled HIV like other chronic diseases. Just as diabetics live full lives, HIV patients do and sometimes rely on organ transplantation.
In Denmark, where HIV treatment is easily available, researchers reported that "The loss of life-years associated with smoking was larger than that associated with HIV".

In other words, smoking reduced life-expectancy more than HIV in patients in Denmark who had access to good, easily-available, free HIV care.
Chronic diseases can often take their toll - especially if initially as many with HIV did not have access to the drugs we have today earlier in the course of their illnesses. The effects of HIV and co-infections with other diseases can lead to damage to important organs - especially the kidneys and liver. Treatments for some disorders associated with HIV can also have side effects that damage side effects. This means that some HIV positive patients are more in need of organ transplantation than other patients.

Monitoring after any transplant can be extensive. There are drug levels that need to be titrated. Patients need to be watched closely for signs of rejection or infection - especially in the early stages after transplant surgery (which can be a complicated operation).

They simply need to monitor their HIV medications and their HIV viral levels as well.

HIV is now a chronic disease, if managed well. There are now 26 unique drugs approved by the FDA for HIV. Successful suppression is possible, but requires management.  Because drugs often have fewer side effects and can be taken less frequently, doctors and patients have chosen to start treatment earlier to stave off any complications of HIV.

Many used to be diagnosed when they developed symptoms. Increased testing has identified the infection earlier.

There have now been transplants in HIV positive patients since 2001. The first donation was of a heart to an HIV positive biostatistician who worked on HIV and co-authored the paper that described his treatment. He had damage to his heart after receiving treatment for an HIV-related cancer, Kaposi sarcoma.

Many subsequent donations have been of kidneys as HIV-related kidney disease is common. Others have received livers as hepatitis viral co-infection (especially Hepatitis C but also Hepatitis B) is relatively common and can be associated with severe liver problems (or cancers) in HIV positive individuals.

To increase the pool of donors, there have been patients who have received organs from HIV positive donors. There is an attempt to avoid introducing any HIV viral resistance, as strains may differ between patients.

There is also the fascinating story of bone marrow transplant in one American patient in Berlin - known as the Berlin patient. He was HIV+ for 12 years and healthy when he developed acute leukemia. For him to survive, his doctors decided he needed a bone marrow transplant.

Such transplants need to be matched specially between donor and recipient. In this case, his doctors found him bone marrow that lacked the CCR5 receptor that HIV needs in order to enter human cells. This was a double CCR5 delta 32 mutation which is found in about 1% of those of European descent and less among other groups. It has allowed hemophiliacs and others have been exposed to HIV, such as through blood transfusions, to not be infected with HIV. With his new bone marrow, the Berlin patient has been able to stop his HIV medications and remain HIV-free. Bone marrow transplants are dangerous and have a high mortality associated.

This will not be the solution for HIV for many others, but it does show insight in how to control HIV immunologically.

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