TRANSPLANTS: AIDS Drugs Lead to Increased Liver Demand
With therapy advancements helping HIV-positive individuals live longer, the "later-blooming" hepatitis C (HCV) has come to rival AIDS as a threat to survival for dually infected patients, USA Today reports. And with 300,000 people suffering from both HIV and HCV, the need for liver transplants has skyrocketed. In fact, a USA Today analysis of organ donation statistics showed that the rate of transplants caused by HCV has quintupled over the past eight years. The problem is most transplant centers reject HIV-positive patients "as a matter of course." Ronald Reisler of the National Institute of Allergy and Infectious Diseases said, "Current transplantation dogma excludes HIV patients from being considered."
Pushing the Envelope
John Fung, the University of Pittsburgh Medical Center's chief transplant surgeon, said many doctors refuse to perform transplants on HIV patients for fear of infection, homophobia or lack of insurance. Fung has performed five successful transplants for HIV-positive patients in the last two years. In addition to Pittsburgh, transplant centers at Mount Sinai Medical Center in New York and the University of California-San Francisco also have "decided to start pushing the envelope" and have launched small-scale studies on liver and kidney transplants for HIV-positive patients. Although the research does not receive federal funding, officials from the National Institute of Allegergy and Infectious Diseases organized a conference to help scientists "talk to each other and try to coordinate their activities." With separate studies showing HIV/HCV patients progressing to end-stage liver disease faster than those with only hepatitis C, Alan Landay, director of clinical immunology at Rush Presbyterian St. Luke's Medical College in Chicago, said it would be discriminatory to deny those patients new organs if "the benefits of transplantation outweigh the risks." He said, "Right now, there are lots of people living with HIV disease. We have to treat them the same as others. I think we have to be fair."
Some physicians, including liver specialist Adrian Di Bisceglie, disagree. He said, "We have a long waiting list of patients for liver transplantation. It grows every day. ... Do we want to add more people to the list and put a strain on an already limited resource?" Fung suggested that one solution to the shortage may be to use organs from donors thought to be infected with HIV or HCV. According to USA Today, organs from upwards of 400 "high-risk donors" are discarded in the United States each year. While transplanting any stranger's organ is risky enough, an additional possible complication associated with HIV-infected individuals is the mixing of AIDS therapies with antirejection treatments. But Peter Stock, transplant surgeon at UCSF, noted that "HIV multiplies and thrives when the immune system is activated," and antirejection drugs "are designed to inactivate that system" (Sternberg, 2/21).