Heart Transplant Successful in HIV-Positive Individual, NEJM Case Report Says
An HIV-positive patient who has been diagnosed with AIDS but has the virus under control can successfully undergo a heart transplant and recover without serious side effects, according to researchers who report on the case of one such individual in today's issue of the New England Journal of Medicine, Reuters Health reports (Mulvihill, Reuters Health, 6/4). While organ transplants for HIV-positive individuals were routinely denied in the past due to the complicated interaction of drugs used to suppress the immune system to prevent rejection of the organ and drugs needed to combat HIV, a 2002 study found that kidney and liver transplants can be as successful in HIV-positive people as in HIV-negative people (Kaiser Daily HIV/AIDS Report, 8/30/2002). The case report describes the case of Dr. Robert Zackin, a 39-year-old man who was diagnosed with AIDS in March 1992 and successfully underwent heart transplantation on Feb. 4, 2001. Advances in HIV treatment can "dramatically dela[y] the progression" of the disease, resulting in an increase in mortality due to organ failure among HIV-positive people and therefore a need for organ transplants, the authors, including Zackin, write. "If HIV-infected patients are now expected to live long and productive lives when they are successfully treated, then they should not be penalized for the advances in medicine that may allow them to benefit from transplantation," the authors state, adding that it "continues to be critical to report ongoing clinical trials as well as individual cases" involving organ transplants among HIV-positive individuals (Calabrese et al., NEJM, 6/5). Dr. Gregory Curfman, executive editor of NEJM, said, "This was a benchmark kind of study." He added that the report should prompt the medical community to discuss the issue of organ transplantation in HIV-positive individuals.
Research has begun to show that HIV infection does not necessarily affect the success or failure of organ transplantation in HIV-positive patients, according to Reuters Health. Most of the transplants among the HIV-positive population so far have involved kidney and liver transplants. NIH is currently conducting a study of 150 kidney transplants and 125 liver transplants in HIV-positive people, according to the study authors (Reuters Health, 6/4). "Liver and kidney transplants showed it was feasible," Dr. Leonard Calabrese of the Cleveland Clinic, who was lead author of the study, said, adding, "We've gone from giving people a pat on the back and watching them die 20 years ago, to being able to treat infections, to now having the prospect of transplanting a vital organ such as a heart" (Reuters, 6/4). This case report, along with other studies on organ transplantation in HIV-positive patients, "provides hope" that some people with HIV/AIDS can benefit from a transplant, and it "opens up the possibilities of synergy and progress" in transplantation, HIV treatment, immunology, pharmacology and public policy, Drs. Michelle Roland and Diane Havlir of the AIDS Division of the Positive Health Program at the University of California-San Francisco, write in an accompanying perspective piece (Roland/Havlir, NEJM, 6/5).