Great News for HIV Patients Who Need Organ Transplants

The United States government has lifted a federal ban on the transplantation of organs from deceased HIV-infected donors to HIV-infected recipients, and the ramifications of this action are expected to be great.

In November, President Obama signed the HIV Organ Policy Equity (HOPE) Act, under which the US Department of Health and Human Services (HHS) and the Organ Procurement Transplant Network (OPTN) will develop and institute standards for research on HIV-positive organ transplantation. If the results of that research are positive, the HHS Secretary may permit positive-to-positive transplantation.

Individuals infected with HIV require a transplant for a number of reasons, including their increased risk for hepatitis C virus (HCV). Consequently, they may develop end-stage liver disease or kidney failure.

An article in Journal of the American Medical Association has reviewed the HOPE Act and the history that led up to it. When HIV first became a medical challenge, most experts believed organ transplantation was impossible and impractical. Their concerns included disease progression in the setting of heightened immunosuppression, and the fact that many patients who had undergone transplantation before infection went into decline and died quickly.

However, advances in transplantation and HIV treatment have removed that contraindication in HIV-infected individuals. If patients have well-controlled HIV, undetectable viral loads, and can manage complex drug regimens that include HIV and transplant medications, then transplantation is an option. But until the HOPE Act was signed into law, those patients were likely to remain on transplant waiting lists and die before an organ could be found. Even today, more than 100,000 patients are actively waiting for life-saving organs, and each year, 10-20% of them die.

Since the actual risk of using organs transplanted from HIV-infected donors is still unknown, infectious disease experts will need to be more closely involved with the transplant screening process, as well as evaluate the potential risk of transmitting drug-resistant HIV or other donor-derived opportunistic infections.