Playwright Larry Kramer’s Liver Transplant a ‘Key’ for HIV Patients
If AIDS activist, novelist and playwright Larry Kramer, who lives with HIV and hepatitis B, has a successful liver transplant at the University of Pittsburgh Medical Center, the surgery "could have importance for the scores of HIV-positive patients today ... who are just beginning to get access to liver transplants," the Pittsburgh Post-Gazette reports. Kramer is one of four HIV-positive patients on UPMC's transplant waiting list, with another four expected to be added soon.Jeff Getty, a friend of Kramer's and fellow activist, said, "This transplant could have a tremendous influence. For people who have HIV, need a transplant and want their insurance companies to pay for it, the Kramer transplant is a high-risk proposition because all eyes will be on Kramer and his survival." In the past, patients with HIV were "ruled out" for transplants because their life expectancy was deemed too short, but with the introduction of antiretroviral drugs in the mid-1990s, their lives have been considerably extended. Still, many transplant centers refuse to perform liver transplants on patients with HIV because the organs are "scarce," and Kramer said that one hospital would not treat him because he had detectable HIV levels in his blood. But Dr. John Fung, chief of transplantation at UPMC, calls Kramer "a good candidate for the operation," adding that he "feels comfortable" performing transplants on patients with detectable viral loads, as long as the virus "will be controllable after the surgery." Kramer also has taken an experimental drug for hepatitis B that has put him "in much better shape" for the surgery. Although Kramer's case could be an important precedent for transplant operations on other patients with HIV, Fung said that he "hope[s] people would look at statistics rather than any one person. I'd like to think that one case doesn't make or break the whole thing."
To research the efficacy of transplants on patients with HIV, the University of California-San Francisco is performing a study that seeks to enroll 75 HIV-positive liver transplant patients over three years in the first phase, and 300 liver, kidney and heart transplant patients in the next phase. The study, which is funded with an NIH grant and currently involves 11 transplant centers including UPMC, will take into account variations in viral load among patients, but will favor enrolling HIV-positive patients who are "relatively healthy," Dr. Michelle Roland of UCSF said. She added, "We're selecting the patient population that is most likely to do well with this intervention, trying to prove the concept that immunosuppression in HIV patients does not accelerate HIV" (Snowbeck, Pittsburgh Post-Gazette, 8/18).
A second transplant candidate with HIV who has appeared in headlines is Belynda Dunn, a Boston AIDS activist living with HIV and hepatitis C, who was "medically cleared" for a liver transplant on Aug. 7 by a UPMC physician committee (Kaiser Daily HIV/AIDS Report, 8/9). Dunn had filed a lawsuit against her HMO, Neighborhood Health Plan, when they refused to cover the cost of the transplant because the surgery was considered "experimental," but dropped the suit after raising $350,000 in donations for the operation, including a $100,000 grant from the HMO (Kaiser Daily HIV/AIDS Report, 7/26).