The Bay Area Reporter - August 27, 1999
Jeff Getty, ACT UP/Golden Gate Writers Pool

Since the transplant, Hext's health has been watched closely by transplant researchers, immunologists, and AIDS activists alike. "The longer I live, the more likely it will be that others with HIV can get organ transplants in the future," Hext said during a recent interview at his Palm Springs home. Hext, who's present appearance could be called a "picture of health," is robust and energetic. Through this last winter and early spring, he experienced a slow but steady recovery. In May, Hext's hepatitis C returned with a vengeance and began to attack his new liver. His hep C viral load skyrocketed and his liver enzymes went out of control. Hext started feeling very poorly and began to lose weight. His doctors immediately began treating him with combination Interferon and Ribavirin therapy. Within three weeks, Hext's liver functions began to normalize and his hep C viral load fell to undetectable levels. "At first the drugs made me feel awful. But after I got used to them, I noticed my appetite and energy returned," recalled Hext.

Hext's bout with hep C and his subsequent recovery marks an important milestone in HIV organ transplantation research. One of the primary reasons for denying HIV patients transplants has been the fear that an HIV and anti-rejection drug-suppressed immune system would not be able to stave off new infections, such as a hep C flare up. Hext's case has proven that an asymptomatic HIV-positive patient's immune system undergoing protease cocktail therapy can be competent enough to function after transplant and cyclosporin-like drugs. Another HIV-positive liver transplant patient has survived for nearly two years without major incident. Many other AIDS diagnosed liver transplant patients from before the age of new HIV cocktail therapies have not survived.

Anyone who meets Hext would immediately see how vital and alive he is. He is a good-looking, solidly built man in his mid-40s -- not the image of a liver failure or AIDS patient. Hext's story is one of incredible will and survival. A year ago he had given up all hope for a transplant in California and was desperately looking to Pittsburgh for help. At the time of transplant, Hext fell for his then-boyfriend's sister and evidently planted his seed. He was not planning to survive. "I thought I was going to die, so I married her," he said. "Now I am about to become the father of a new baby boy. I am gay, but I want to have a family just the same. Who would believe my story, if they read it in a book?" Hext wondered.

Recently, Hext sent a note along with a picture of himself, to a San Francisco community advisory board (CAB) that currently advises UCSF researchers on HIV liver and kidney transplantation. CAB members passed around Hext's card and smiled as UCSF HIV physician Michelle Roland and UCSF organ transplant surgeon, Dr. Peter Stock unveiled a semi-final HIV organ transplant protocol draft last week. The latest protocol calls for up to 10 kidney and liver transplants to take place with patients who have greater than a nadir (all time low count) of 200 CD4 cells and no previous AIDS defining opportunistic infections. CAB members agreed that since there were plenty of patients waiting for organs that met this criteria, it would be best to start with healthier patients first. It is hoped that healthy HIV asymptotic patients will have a much better survival rate. Liver transplant survival rates are about 8 in 10 for normal HIV-negative patients. CAB members agreed that the higher the HIV-positive patient survival rate, the more likely it will be for medical insurance payment and HIV inclusion in future transplants. Unfortunately, patients with low CD4 numbers or progressed AIDS will be turned away for now. This decision was not taken lightly by the group.

The UCSF protocol is expected to be finished and approved by October. Since Assemblywoman Carole Migden (D-San Francisco) was able to get funding for the research in this year's state budget, it is likely that the first transplants will be ready to take place as organs become available in the coming year. There is a waiting list already and researchers are hoping that other new patients can wait until other sites begin transplants possibly next year. In September, organ transplant researchers and activists will participate in an all-day workshop at the National Institutes of Health (NIH). It is hoped that a national multi-site research proposal will come out of this meeting. With the NIH funding a multi-site transplant protocol, patients chances for receiving vital organ transplants will increase dramatically.

It appears that an avenue is slowly opening for people with HIV to live more normal lives. The future will also include participation in previously forbidden medical procedures. Hopefully upcoming patients will have strength and tenacity like Alan Hext, so that the door to transplant equality remains open.

ACTion UPdate

Drug recycling info

Contrary to recent denialist propaganda in San Francisco, HIV still causes AIDS and HIV drug recycling can save lives in South America and Africa. Please contact Homer Hobi at (415) 285-1981 if you have drugs to donate.
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