Miami Herald - August 13, 2001

"I think it just goes along with the idea that if you have HIV, you've got the black plague," said Dunn, a 49-year-old Boston AIDS activist who has worked to stop the spread of the Human Immunodeficiency Virus for the past decade.

Five years ago, doctors and insurers routinely rejected AIDS patients for transplants because of their lower life expectancies and the unproven benefits of transplant surgery in such patients. Since transplant patients must take drugs to suppress the body's attempts to reject new organs, doctors assumed that the medication would exacerbate problems in HIV patients, who have weaker immune systems.

But in the past few years, as new drugs have significantly increased the life expectancies of HIV patients, doctors are beginning to perform more transplants.

"It's very leading edge," said Dr. Guy Neff, transplant hepatologist at the University of Miami. The increasing effectiveness of the antiretroviral drugs, known as HAART regimens, "has opened up the door that these patients who are dying of liver disease with HIV are possible candidates for transplant."

UM has done six liver transplants in HIV patients who were also infected with hepatitis B and/or C. The first was done about 2 1/2 years ago, the most recent two months ago. All six recipients are in good shape, Neff said.

In 1999, five such transplants were reported to the United Network for Organ Sharing. In 2000, there were 11. Only 37 have been done on HIV patients in the past 12 years, according to the organ network. The numbers do not reflect all transplants, because some states have laws against disclosure of information on people with HIV.

"Most places, it's hotly debated whether we should be doing these," Neff said. "Most surgical staffs are not really keen on doing it." That's not the case at UM. "The central message is that the antiretrovirals change the disease so much it's a different story," said surgeon Andreas Tzakis, co-director of UM's transplant program. "The patients we have done have all done very well."

In Dunn's case, Neighborhood Health Plan rejected her transplant as experimental. Chief executive James Hooley said there isn't enough evidence to tell whether the procedures are safe or can prolong the lives of HIV patients.

The University of California San Francisco Medical Center is organizing a clinical trial in as many as 15 U.S. hospitals -- the largest of its kind for HIV transplant patients, said Dr. Peter Stock, a transplant surgeon involved in the study. UM is not participating.

Once the clinical trial has been completed, Stock said, insurance companies may be less likely to consider the procedure experimental. "In order to get insurance companies to pay, you have to show that it's safe and effective."

Empire Blue Cross and Blue Shield changed its policy earlier this year to allow people with HIV to be considered for transplants.

"The previous policy basically said that HIV was too significant a risk factor for consideration of transplants," said Dr. Alan Sokolow, Empire's chief medical officer. "Now that we know more about how HIV and transplants interact, it's possible to consider certain situations of HIV infection to be acceptable conditions for transplant."

The main reason for the change is the improved prognosis for people with HIV since the widespread use, beginning in 1996, of the HAART regimens. When the virus is controlled, the disease process slows down.

Some of the drugs can be toxic to the liver, Neff said. "Most patients are not dying from their HIV/AIDS, they are dying of liver disease."

Larry Kramer, a New York writer who has helped focus attention on the AIDS epidemic for two decades, agreed that a growing number of HIV-infected patients need transplants because they're also infected with hepatitis.

"This is a major problem facing this country and this world," said Kramer, who is on the waiting list at the University of Pittsburgh Medical Center for a liver transplant because he has hepatitis.

The center has performed seven liver transplants on HIV patients since 1998. Their survival rates have been comparable to those of transplant patients without HIV, said Dr. Andrew Bonham, a liver transplant surgeon there. One patient died in the first two weeks from surgical complications, while another died 18 months later from chronic rejection of the organ. The other five are still alive.

Herald medical writer Christine Morris contributed to this report.

010813
MH010802

Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2001. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .