Study shows organ donation between HIV-infected is feasible, desirable

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NEJMThe results of a new study support something advocates both domestically and globally have been pushing for years: organ donation from people infected with HIV to others living with HIV. The study, published in the New England Journal of Medicine, shows outcomes for HIV-infected patients who received kidney transplants from HIV-infected individuals are similar to that of noninfected patients. Results indicate transplantations are not only feasible but desirable for many patients, according to a NEJM editorial.

Researchers followed 27 HIV-infected patients who received kidney transplants from donors who died from HIV-related complications and found that results measured at 3 and 5 years “compare favorably with reported outcomes in HIV-positive patients who received kidneys from HIV-negative donors.”

The study cites that a major concern surrounding transplantations from HIV-infected donors to HIV-infected recipients is the “risk of transmission of a new and possibly resistant strain of HIV from donor to recipient,” but the patients in this study “did not have any increase in plasma viral load, and viral levels remained undetectable after transplantation.”

Chronic kidney disease occurs in as many as 20 to 27 percent of people living with HIV who are not on antiretroviral treatment, and many of these patients will require either dialysis or kidney transplantation, but according to the NEJM editorial “dialysis has not been widely available for patients with HIV infection in South Africa,” and transplantation is “generally superior to other forms of renal-replacement therapy.”

The marked world-wide shortage of kidney donors is exacerbated in South Africa, where many eligible donors are themselves infected with HIV, so results from this study are promising according to Julie Ingelfinger and Eric Rubin, who write in a NEJM editorial, “this study shows that using infected donors is a reasonable strategy for renal-replacement therapy and has implications that extend beyond South Africa.”

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