HIV-to-HIV transplantation has not been accepted as standard of care due to concerns that organ recipients will become infected with other strains of HIV.
People with HIV can safely receive donated kidneys from deceased donors who have the virus, a large new study says as the US government moves to expand the practice. Research shows this could shorten the wait for organs for everyone, regardless of HIV status.
The study, published in the New England Journal of Medicineanalyzed almost 200 kidney transplants performed in the United States. The researchers said they found similar results whether the donated organ came from a person with or without the AIDS virus. Johns Hopkins Medicine researchers say their study findings support formally adopting the use of organs from HIV-positive donors as standard clinical practice for people with HIV who need a kidney transplant.
Kidney transplants for HIV are not accepted for fear of becoming infected
HIV-to-HIV transplantation has not been accepted as standard of care due to concerns that organ recipients would become infected with other strains of HIV, leading to so-called HIV superinfection. According to experts, the need for recipients’ continued post-surgical immunosuppression would damage the donated organ or lead to a resurgence of the recipient’s HIV viral blood counts.
A serious complication in any transplant is that the recipient’s immune system would recognize the donated organ as “foreign” and attack it, much as it would an invading virus. For this reason, immunosuppressive medications are used to prevent organ transplant rejection. However, the early success of HIV-to-HIV kidney transplantation alleviated these concerns.
How was the study carried out?
For the study, participants who had kidney failure and were HIV positive agreed to receive an organ from an HIV-positive deceased donor or an HIV-negative deceased donor, whichever kidney was available first. Researchers followed organ recipients for up to four years, comparing half of those who received kidneys from HIV-positive donors with those whose kidneys came from HIV-negative donors.
The study concluded that both groups had equally high rates of overall survival and low rates of organ rejection.
Virus levels increased in 13 patients in the HIV donor group and four in the other group, mostly related to patients who were not taking HIV drugs consistently, and in all cases they returned to very low levels or undetectable. However, researchers attributed the incidences to recipients not taking their antiviral medications as prescribed, and viral suppression returned with stricter adherence to drug treatment. A superinfection was detected but without clinical effects on the organ recipient. “This demonstrates the safety and fantastic results we are seeing with these transplants,” said study co-author Dr. Dorry Segev from NYU Langone Health.
HIV Positive Patients Fight Stigma and Outdated State Laws
According to experts, those who are HIV positive have been actively discouraged from registering as organ donors due to stigma and outdated state laws and policies that criminalize this measure. Therefore, this result not only tends to help those living with this disease, but also frees up more organs in the entire organ pool so that those without HIV can obtain an organ faster.
More than 90,000 people are on the waiting list for kidney transplants, according to the US Organ Procurement and Transplantation Network. In 2022, more than 4,000 people died waiting for kidneys.
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