HIV-to-HIV transplantation has not been accepted as the standard of care due to concerns about organ recipients becoming infected with other strains of HIV
Those with HIV can safely receive donated kidneys from deceased donors with the virus, a new large study says as the US government moves to expand the practice. According to research, this could shorten the wait for organs for all - regardless of HIV status.
The study, published in the New England Journal of Medicine, looked at nearly 200 kidney transplants performed across the US. Researchers said they found similar results whether the donated organ came from a person with or without the AIDS virus. Researchers from Johns Hopkins Medicine say their study findings support formally adopting the use of organs from donors with HIV as standard clinical practice for people with HIV in need of kidney transplantation.
HIV kidney transplants are not accepted due to fear of infection
HIV-to-HIV transplantation has not been accepted as the standard of care due to concerns about organ recipients becoming infected with other strains of HIV – which led to the so-called HIV superinfection. According to experts, recipients' need for ongoing post-surgical immunosuppression would damage either the donated organ or lead to a resurgence of the recipient's HIV viral blood counts.
A serious complication in all transplantation is that the recipient's immune system would recognize the donated organ as "foreign" and attack it, much like it would an invading virus. And so, for this reason, immune-suppressing drugs are used to prevent organ transplant rejection. However, early success with HIV-to-HIV kidney transplantation alleviated these concerns.
How was the study performed?
For the study, participants who had kidney failure and were HIV-positive agreed to receive an organ from either an HIV-positive deceased donor or an HIV-negative deceased donor, whichever kidney became available first. Researchers followed the organ recipients for up to four years, comparing half of those who received kidneys from HIV-positive donors to those whose kidneys came from donors without HIV.
The study concluded that both groups had similarly high rates of overall survival and low rates of organ rejection.
Virus levels rose for 13 patients in the HIV donor group and four in the other group, mostly tied to patients failing to take HIV medications consistently, and in all cases returned to very low or undetectable levels. However, the researchers attributed the incidences to recipients' not taking their antiviral medications as prescribed, and viral suppression returned with tighter adherence to drug treatment. One superinfection was detected but with no clinical effects on the organ recipient. “This demonstrates the safety and the fantastic outcomes that we’re seeing from these transplants,” said Dr. Dorry Segev, study co-author of NYU Langone Health.
HIV-positive patients battle stigma, outdated state laws
According to experts, those who are HIV positive have been actively discouraged from signing up to be organ donors due to stigma and outdated state laws and policies that criminalize the move. So, this outcome not only tends to help those living with this disease but also free up more organs in the entire organ pool so that those who don’t have HIV can get an organ faster.
More than 90,000 people are on the waiting list for kidney transplants, according to the US Organ Procurement and Transplantation Network. In 2022, more than 4,000 people died waiting for kidneys.
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