Kidneys transplanted between HIV patients

[Roon]

ATLANTA - South African surgeons have transplanted kidneys between donors and patients who were both infected with the AIDS virus — a medical first that has some U.S. doctors buzzing about whether it could be tried here.

The first four of the transplants, which occurred in 2008, are described in Thursday's New England Journal of Medicine.

Five more have been done since then at the same Cape Town hospital, Groote Schuur. It's the only medical center in the world to have done them, said one of the transplant surgeons, Dr. Elmi Muller.

http://www.msnbc.msn.com/id/37739716/ns/health-health_care/

[DeadEyeDyck]

1. Hmmmmmmmmmmmmmmmmm

Kinda like changing a flat with a flat!

[kestrel91316]

2. Errrr, nope. FAIL. HIV does many things, but destroying kidneys is not one of them.

[REP]

7. Wrong. HIV can cause HIV nephropathy and FSGS, especially in non-whites

FSGS, no matter what its etiology, is more common in black men, so I'm not surprised it's not well known. I wouldn't know about it except that I have primary idiopathic (non-HIV etc) FSGS myself, and I'm a white woman without HIV. HIV associated FSGS is more common in African countries.

[kestrel91316]

14. Well, one assumes that kidneys from HIV patients would be screened for that

before transplanting, then.

[CaliforniaPeggy]

3. No, it's not like that at all...

Transplanting kidneys between two HIV patients is a good idea because you don't need to worry about spreading HIV.

One of them is in kidney failure and the other person isn't...

It's a great idea.

[REP]

8. Except transplant doesn't cure FSGS no matter the cause (except heroin use)

I'm pretty sure HIV nephropathy would recur in a txd organ in an HIV+ recipient as well.

[moriah]

12. Remember that HIV mutates rapidly....

The recipient of the transplant now will have two variants of the virus -- which may significantly increase resistance to HIV meds. That's why even couples who are both HIV+ are recommended to have protected sex.

Let's say that one person's virus is currently being treated well with Combivir and Sustiva (a very common first-line treatment regimen consisting of AZT, 3TC, and EVF). The other person has been treated with AZT in the past as a single-drug, and has developed resistance to it, and is now on Truvada and Kaletra (a common second-line treatment consisting of TDF, FTC, and the protease inhibitor LPV). They think that since both of them have HIV that they don't have to use condoms, but now both are infected with both virus strains, and they merge to some degree.

The Combivir/Sustiva work fairly well at first because at least two of the three drugs are active, but the virus from the partner that is being treated with Truvada/Kaletra gets into the first person's blood, and is no longer getting the Truvada/Kaletra. Just like bacteria, the virus that survives treatment is at least somewhat resistant to the drugs it's being given, and once it stops getting those drugs it will reproduce and flourish, spreading those resistance genes.

When the Combivir/Sustiva regimen fails (as it seems eventually every regimen does), the person goes to their doctor. The doctor, under the impression that his virus has only been exposed to one regimen of drugs, tries a second level treatment. He decides on Atriplia and a protease inhibitor. Atriplia contains EFV (Sustiva), but it also has two other drugs that the doctor thinks he shouldn't have resistance to -- TDF and FTC, so he thinks it will work. Alas, his virus is already resistant to all three, so this regimen is doomed to fail quickly, and will also make the virus resistant to whatever protease inhibitor he gives with it, because the protease inhibitor will be working alone... whatever virus it doesn't kill will be resistant (whereas in a normal second-line regimen, whatever virus isn't killed by the protease inhibitor will usually be killed by the other antiretrovirals).

[Bluebear]

4. Spectacularly stupid.

[REP]

9. Not at all. Apparently, more aware of HIV nephropathy/FSGS in non-whites than others

[Bluebear]

10. Yes it is. Equating an HIV+ person to something deformed like a flat tire?

Ugh.

[REP]

11. Ever seen a kidney scarred by FSGS/ESRD?

[old mark]

5. Prolonging someone's life is a great idea - as long as te HIV is under control

the recipient may have added many years to his life.

What is wrong with that?

rec

mark

[Chulanowa]

6. Okay, I hope this isn't regarded as an unempathic question or something...

But given the effect HIV / AIDS has on the immune system, shouldn't organ transplants be somewhat easier on those afflicted? I know many organ recipients have to stay on immune repressing drugs for a long time, if not the rest of their lives. How's this work with those infected with HIV / afflicted with AIDS?

[moriah]

13. I don't know, but ....

... the transplant recipient is going to have a much harder time fighting the virus off because they're going to have two strains of HIV now, along with all the drug resistance that other strain of HIV has. You remember that poster that said "How well do you know the 64 people you slept with last night?" A question for a person with HIV who is planning on any activity that might give them a new strain of the virus would be "Do you know what anti-retrovirals the 64 people you slept with last night have taken?"

Dad reached "the end of the line" with anti-retrovirals about a year and a half before he finally died. I don't know if risk-taking activity with other people who were already HIV+ contributed, or if it was just because he wasn't religious about taking his meds at first (he suffered a lot of horrible side effects, and started treatment before protease inhibitors were available so he had been given single-drug treatments like just AZT or just ddI), but new treatments couldn't keep up with his mutations. Fuzeon was the last available treatment, and he tried it (along with a few other ones that resistance testing had shown he was the least resistant to, nothing works by itself usually) but only was successful with it for about 8 months.

If the patient consents and believes it is worth the risk, I say go for it... but it's not at all a safe thing to do, any more than two HIV+ people sharing needles or having unprotected sex would be.