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More AIDS Patients Get Organ Transplants: New 5 yr NIH Study of Liver Transplantation in HIV/HCV+
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Boston Globe
Feb 28, 2004
Stephen Smith
As treatment extends HIV patients' lives, they are increasingly threatened by failing organs - often from diabetes, hepatitis, and other illnesses - rather than the infections thatproved so deadly earlier in the epidemic. Still, not every surgeon or insurance company believes performing transplants on HIV-infected patients is a good idea, even though nearly 100 havealready been performed.
Helping to address the issue, the National Institutes of Allergy and Infectious Diseases and researchers at 17 transplant centers have begun a five-year, $17 million study to examine theoutcomes of kidney and liver transplantation among 275 male and female HIV patients whose virus is under control. In February, Boston's Beth Israel Deaconess Medical Center was authorized to sign up prospective patients.
The need for donated organs is beyond dispute. Studies estimate that up to one-third of HIV-patients are co-infected with hepatitis C, and 10 percent have hepatitis B.
"It's really only been in the last year or two where I think many of us have begun to realize how good the AIDS therapy has become and how many of these patients are doing well enough tomake them eligible for transplants," said Dr. Douglas Hanto, transplant chief at Beth Israel.
No formal ban prohibited transplants in HIV patients earlier, but the prospect of an AIDS death persuaded most hospitals that transplants would be better performed on longer-living people.
One study released three months ago found that of 24 HIV-positive patients who had liver transplants, 87 percent were still alive - a figure identical to results for uninfectedpatients. There was also no evidence that HIV patients were more likely to see their virus go out of control from anti-rejection medicines.
In another study, University of California-San Francisco researchers found that five of 10 HIV-positive kidney recipients experienced significant episodes of rejection - higher thanusual. The reasons were unknown, but doctors speculate it may reflect their timidity in using high doses of anti-rejection drugs. The federally funded study now aims to determine how muchanti-rejection medication should be given and its effect in combination with AIDS drugs.
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