Liver and kidney transplants are just as likely to be successful in people with HIV compared to HIV-negative people according to four studies presented to the 2002 meeting of the International Congress of the Transplantation Society in Miami, Florida between 25 and 30 August. This will come as welcome news to the many people with HIV who are living with liver damage, notably caused by co-infection with the viruses hepatitis B or C, or kidney failure which can be caused by medication used to treat HIV or HIV-related illnesses.
Investigators from hospitals in the USA and France presented data which indicate that after more than one year of follow-up, the survival rate of HIV-positive patients receiving new livers and kidneys was very similar to those of transplant patients without HIV.
Although the use of immunosuppressive drugs to prevent organ rejection seemed to have little effect on the speed of HIV disease progression, investigators reported difficulties managing interactions between anti-rejection therapies and HAART.
Four studies reported encouraging results.
Doctors at Hahnemann University Hospital in Philadelphia, have performed 20 kidney transplants on people with HIV. Of these, 17 are alive and well a year after their operations and have HIV viral loads either undetectable or very low, just as they were before the transplant was carried out. However, an interaction between the anti-rejection drugs and HAART did result in one patient losing his transplant.
Similarly hopeful results were reported by investigators at the University of California, San Fransciso, who reported the results of four liver and ten kidney transplants performed on HIV-positive patients. After a year of follow-up, there was no evidence of HIV progression or any adverse effect of HIV on the transplanted organs and HIV viral loads were undetectable in all the transplant recipients taking HAART. An interaction between protease inhibitors and the anti-rejection drug cyclosporin meant that a therapeutic level of the drug was achieved giving only a quarter of the dose given to those HIV-positive patients treated with a HAART regimen containing a non-nucleoside reverse transcriptase inhibitor (NNRTI).
Drug interactions between protease inhibitors and anti-rejection drugs were also reported in a French study presented to the Congress. Investigators at the Paul Brousse Hospital in Villejuif, France found that an interaction between protease inhibitors and the anti-rejection drug tacrolimus caused organ rejection in one patient and toxic levels of tacrolimus in another. However, of the six HIV-positive patients co-infected with hepatitis C who received new livers at the hospital, all but one was alive and well a year after the transplant with low or undetectable viral loads and improved quality of life.
An interaction between protease inhibitors and tacrolimus was also found by investigators at the University of Pittsburg who reported on the outcome of seven liver and four kidney transplants performed on HIV-positive people.