"The blanket exclusion 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," write Drs. Peter G. Stock and Michelle E. Roland of University of California, San Francisco, (UCSF) in the Transplantation journal.
Modern treatments—especially the highly active antiretroviral therapy (HAART)—have greatly decreased the risk of death from AIDS and other causes in patients with HIV. However, as they live longer, patients develop other complications, including kidney and liver disease related to hepatitis B and C infection. The HAART drugs can also have toxic effects on the liver.
Stock and Roland cite progress in several key areas—including the ability to control HIV infection using HAART and improved measures to prevent opportunistic infections—that have made organ transplantation an increasingly viable option for HIV-positive patients. Studies performed in the "post-HAART" era at UCSF and elsewhere have shown promising results. In one study of liver transplantation in HIV-positive patients, the three-year survival rate was 73 percent—similar to that of HIV-negative patients.
At transplant centres worldwide, criteria for considering transplantation in HIV-positive patients are "slowly being liberalized," according to the authors. In most cases, patients must have "undetectable" HIV levels before kidney transplantation can be considered. At first it was thought that, because of their weakened immune systems, HIV-positive patients would need less immunosuppressant therapy to prevent transplant rejection. However, early experience has suggested that rejection rates may be higher in HIV-positive patients, especially early after kidney transplantation. There is also evidence that some of the immunosuppressant drugs given after transplantation also have antiretroviral (anti-HIV) effects.
MEDICA.de; Source: Lippincott Williams & Wilkins