- Johns Hopkins approved to perform HIV-positive to HIV-positive organ transplants
- The waiting list
- Johns Hopkins Experts Available in Observance of World AIDS Day
- Patients with rare natural ability to suppress HIV shed light on potential functional cure
- HIV and AIDS
- Sexual contact
- Blood contamination
- HIV/AIDS cannot be spread through:
- How is HIV/AIDS diagnosed?
- Starting HIV treatment in ERs may be key to ending HIV spread worldwide
- New Source Of Transplant Organs For Patients With HIV: Others With HIV
- Johns Hopkins Performs First Kidney Transplant From Living Donor Who Has HIV
Johns Hopkins approved to perform HIV-positive to HIV-positive organ transplants
- Johns Hopkins will be the first in the nation to do an HIV-positive kidney transplant
- The hospital will first in the world to execute an HIV-positive liver transplant
(CNN)It could mean the difference between life and death for more than 1,000 people in the United States each year.
Doctors at Johns Hopkins University in Baltimore have been given the okay to become the first hospital in the country to perform HIV-positive to HIV-positive organ transplants.
“This is an unbelievably exciting day for our hospital and our team, but more importantly for patients living with HIV and end-stage organ disease,” said Dorry Segev, associate professor of surgery at the Johns Hopkins School of Medicine. “For these individuals, this means a new chance at life.”
Until the HOPE Act — HIV Organ Policy Equity Act — passed in 2013, doctors were prevented from using organs from HIV-positive donors, even if they were intended for an HIV-positive patient.
Now that's no longer an issue.
Segev estimates the number of HIV-positive would-be organ donors in the United States at 500-600 annually. Their organs could save more than 1,000 people.
A study by the University of Pennsylvania put the number of potential HIV-positive donors at nearly 400.
“The findings are significant because there are not enough organ donors in the United States to meet the needs of all of the patients who might benefit from life-saving organ transplants,” said Emily Blumberg, a professor at the Perelman Center for Advanced Medicine at the University of Pennsylvania.
“Some of the patients waiting for organs are infected with HIV but never make it to transplant because they either die while waiting or become too sick to be transplanted.”
There was more than a two-year lag between passage of the HOPE Act and Johns Hopkins' approval. The National Institutes of Health spent the time developing criteria and safeguards for the transplants since little is known about them.
The waiting list
In 2014, there were some 121,000 people in the United States on the waiting list for an organ transplant, according to the U.S. Department of Health. Only one in four received a transplant, so there's a real shortfall in donor organs available.
The HOPE Act was inspired by an organ transplant program in South Africa that showed positive outcomes for non-HIV transplants in HIV-positive recipients and the proven results of HIV-positive to HIV-positive kidney transplants.
With its recent approval by the United Network for Organ Sharing, Johns Hopkins will become the first hospital in the nation to do an HIV-positive kidney transplant and the first in the world to perform an HIV-positive liver transplant.
The timing will depend on organ availability and patient match.
“Organ transplantation is actually even more important for patients with HIV, since they die on the waiting list even faster than their HIV-negative counterparts,” Segev said. “We are very thankful to … use organs from HIV-positive patients to save lives, instead of throwing them away, as we had to do for so many years.”
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Johns Hopkins Experts Available in Observance of World AIDS Day
Nearly 40 million people around the world are living with HIV, and experts believe about 20% do not know their status. In the U.S., more than 1 million people in the U.S. are living with HIV.
In observance of World AIDS Day on Dec. 1, the following experts are available to speak about HIV/AIDS, including the current state of the virus and disease, how far we’ve come, research and what’s in the future:
- Allison Agwu, M.D.Associate Professor of Medicine and Pediatrics, Johns Hopkins University School of MedicineDirector, Pediatric and Adolescent HIV/AIDS Program, Johns Hopkins Children CenterTopics: HIV/AIDS in children and adolescents; treatment and management strategies
- Larry Chang, M.D., M.P.H.Associate Professor of Medicine, Johns Hopkins University School of MedicineTopics: HIV epidemic in Africa and Uganda; implementation science relating to antiretroviral therapy; use of mobile health technology and HIV
- Richard Chaisson, M.D.Professor of Medicine, Johns Hopkins University School of MedicineDirector, Johns Hopkins University Center for AIDS ResearchTopics: General AIDS; Tuberculosis/HIV co-infection
- Natasha Chida, M.D., M.S.P.H.Assistant Professor of Medicine, Johns Hopkins University School of MedicineAssistant Director, Infectious Diseases Fellowship ProgramTopic: Care of patients with HIV in the U.S.
- Christine Durand, M.D.Associate Professor of Medicine, Johns Hopkins University School of MedicineTopics: Cancer therapy and transplant in people living with HIV; HIV Organ Policy Equity (HOPE) Act, which allows HIV-positive organ donors to donate to HIV-positive patients who need a transplant
- Charles Flexner, M.D.Professor of Medicine, Johns Hopkins University School of MedicineDirector, Johns Hopkins University AIDS Clinical Trials UnitTopics: Medication to prevent and treat HIV; development of long-acting, extended release HIV drugs
- Bhakti Hansoti, M.B.Ch.B., Ph.D., M.P.H.Associate Professor of Emergency Medicine, Johns Hopkins University School of MedicineTopics: Emergency medicine; missed HIV population; HIV testing implementation in the emergency department
- Deborah Persaud, M.D.Professor of Pediatrics, Johns Hopkins University School of MedicineTopics: HIV-cure research for children
- Richard Rothman, M.D., Ph.D.Professor of Emergency Medicine, Johns Hopkins University School of MedicineVice Chair of Research, Department of Emergency Medicine, The Johns Hopkins HospitalTopics: National and local HIV testing programs in emergency departments (EDs); novel approaches and tools for HIV testing in acute care settings; pre-exposure prophylaxis (PrEP) in EDs; acute HIV and early treatment in EDs; research on gaps in the HIV care continuum
- Thomas Quinn, M.D.Professor of Medicine, Johns Hopkins University School of MedicineDirector, Johns Hopkins Center for Global HealthTopics: International perspectives on HIV; the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to respond to the global HIV/AIDS epidemic; research initiatives in HIV
If you would to interview one of the Johns Hopkins Medicine experts, please contact Kim Polyniak, senior communications specialist, public relations and corporate communications, at email@example.com or 443-510-5807.
Patients with rare natural ability to suppress HIV shed light on potential functional cure
Researchers at Johns Hopkins have identified two patients with HIV whose immune cells behave differently than those of others with the virus and actually appear to help control viral load even years after infection.
Moreover, both patients carry large amounts of virus in infected cells, but show no viral load in blood tests. While small numbers, the data suggest that long-term viral remission might be possible for more people with HIV.
A report of the findings was published online in the Journal of Clinical Investigation Insight.
“One of our patients was infected nearly 20 years ago, spent a few years on antiretroviral therapy, then stopped ART and has been 'virus-free' for more than 15 years,” says Joel N.
Blankson, professor of medicine at the Johns Hopkins University School of Medicine and last author of the study.
“Our findings suggest that early treatment with ART can reset a patient's immune system to the point where the virus can be controlled even when ART is discontinued.”
He adds: “Understanding how this occurs could lead to a 'functional cure' for HIV-infected patients.”
HIV infects so-called CD4+ T cells of the immune system and uses those cells to replicate and generate more virus. During early stages of infection, another type of immune cell, known as CD8+, identifies and kills HIV-infected CD4+ T cells, but typically the virus replicates so rapidly that the CD8+ T cells are not able to keep up and themselves die off.
“Our findings suggest that early treatment with [antiretroviral therapy] can reset a patient's immune system to the point where the virus can be controlled even when ART is discontinued.”
Joel N. Blankson
Professor of medicine
For this study, the researchers have been following two HIV-infected men who had undetectable levels of HIV in their routine testing.
One of the men is what is known as an elite suppressor, meaning he carries a genetic marker on his immune cells that enables his body to naturally keep viral levels low without treatment; the other patient is what's known as a post-treatment controller, who took ART for a few years before stopping 15 years ago and does not carry any protective genetic markers.
As part of the patients' regular visits over the years, blood has been collected for testing viral load. From these blood samples, the researchers separated out the CD4+ T cells. Both patients had high numbers of HIV-infected CD4+T cells despite no measurable viral load in their blood—an unusual characteristic for any HIV-infected patient who is capable of controlling the virus.
Previously, evidence of a large viral reservoir in CD4+ T cells was thought to be a barrier to HIV eradication because reservoirs contain copies of the virus that are able to replicate and spread. However, this didn't seem to be happening in these patients, so the researchers wanted to determine why.
Having collected samples from these patients over the years, the researchers isolated virus and sequenced the genetic material, finding that the virus from 2010 and two samples collected six months apart in 2017 were identical. This result was surprising, because when HIV replicates it tends to mutate as a natural evolution process that allows the strongest versions to propagate.
“The fact that the viruses were completely identical suggests that replication occurred through a process known as clonal expansion, where infected resting cells in the reservoir divide, leading to exact copies of all the viral genes being made,” Blankson says.
After establishing that these viruses were identical, the researchers then asked whether it was CD8+ T cells playing a role in somehow controlling the virus. The team isolated CD8+ T cells from each patient and mixed them with virus-infected CD4+ T cells from the same patient; they also mixed CD8+ T cells from other, noncontroller patients with their own infected CD4+ T cells.
They found that the controller's own CD8+ T cells were able to suppress that patient's virus, but noncontroller CD8+ T cells were not able to suppress their own virus.
This suggests that the behavior of CD8+ T cells in the controller patients was the key to why they had been able to maintain undetectable viral loads for an extended period of time despite large numbers of infected CD4+ T cells.
“We believe this is the first time that an HIV-specific CD8+ T cell response has been shown in a post-treatment controller,” says Rebecca T. Veenhuis, a research associate at the Johns Hopkins University School of Medicine. “The results suggest that a functional cure can occur despite a large viral reservoir.”
Posted in Health
hiv/aids, immunology, autoimmune disease
HIV and AIDS
AIDS (acquired immunodeficiency syndrome) is caused by the human immunodeficiency virus (HIV).
This kills or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers. HIV is most commonly spread by sexual contact with an infected partner.
Another important means of spreading HIV is contact with infected blood from contaminated needles, syringes, or other drug paraphernalia.
The term AIDS applies to the most advanced stages of an HIV infection.
The current definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ T cells (healthy adults usually have CD4+ T-cell counts of around 800 or more.
) In addition, the definition includes HIV-infected people who have been diagnosed with one or more clinical conditions (including opportunistic infections and certain cancers) that affect people with advanced HIV disease.
According to the CDC, an estimated 1 million adults and adolescents are living with HIV/AIDS in the United States. The AIDS epidemic still rages control in many areas of the world.
HIV is spread most commonly by sexual contact with an infected partner. The virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth during sexual activity.
HIV may also be spread through contact with infected blood. However, due to the screening of blood for evidence of HIV infection in the U.S., the risk of acquiring HIV from blood transfusions is extremely low.
HIV is often spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus. Transmission from patient to healthcare worker, or vice-versa through accidental sticks with contaminated needles or other medical instruments, is rare.
HIV also can be spread to babies born to, or breastfed by, mothers infected with the virus.
HIV/AIDS cannot be spread through:
- Casual contact, such as sharing food utensils, towels, and bedding
- Swimming pools
- Toilet seats
- Biting insects (such as mosquitoes)
Some people may develop a flu- illness within a month after exposure to the HIV virus. But many people do not develop any symptoms at all when they first become infected. In addition, the symptoms that do appear, which usually disappear within a week to a month, are often mistaken for those of another viral infection. These may include:
- Enlarged lymph nodes
Persistent or severe symptoms may not surface for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with an HIV infection. This “asymptomatic” period of the infection is highly variable from person to person.
But, during the asymptomatic period, HIV is actively infecting and killing cells of the immune system. Its most obvious effect is a decline in the blood levels of CD4+ T cells (also called T4 cells)—a key immune system infection fighter.
The virus initially disables or destroys these cells without causing symptoms.
As the immune system deteriorates, complications begin to surface. The following are the most common complications, or symptoms, of AIDS. However, each individual may experience symptoms differently. Symptoms may include:
- Lymph nodes that remain enlarged for more than 3 months
- Lack of energy
- Weight loss
- Frequent fevers and sweats
- Persistent or frequent yeast infections (oral or vaginal)
- Persistent skin rashes or flaky skin
- Pelvic inflammatory disease that does not respond to treatment
- Short-term memory loss
- One or more infections (opportunistic infections) related to having a weakened immune system. These include tuberculosis and certain types of pneumonia.
Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease known as shingles. Children may have delayed development or failure to thrive.
During the course of the HIV infection, most people experience a gradual decline in the number of CD4+ T cells. Though some individuals may have abrupt and dramatic drops in their counts.
The symptoms of an HIV infection may resemble other medical conditions. Always talk with your healthcare provider for a diagnosis. Rapid diagnostic tests are available and early diagnosis is important.
How is HIV/AIDS diagnosed?
Early HIV infection often causes no symptoms, and must be detected by testing a person's blood for the presence of antibodies—disease-fighting proteins—against HIV.
These HIV antibodies generally do not reach levels high enough to detect by standard blood tests until 1 to 3 months following infection, and may take as long as 6 months.
People exposed to HIV should be tested for HIV infection as soon as they think they may have been exposed to HIV.
When a person is highly ly to be infected with HIV and yet antibody tests are negative, a test for the presence of HIV itself in the blood is used. Repeat antibody testing at a later date, when antibodies to HIV are more ly to have developed, is often recommended.
As with many other conditions, early detection offers more choices for treatment.
Today, there are medical treatments that not only can slow down the rate at which HIV weakens the immune system, but also may keep HIV in check so that the individual has a chance to live a normal life span.
Unfortunately, there is no cure for an HIV infection. Talk with your healthcare provider for more information regarding various drug therapies for the treatment of HIV/AIDS.
HIV is still spreading worldwide. Research continues to provide more insight to possible vaccine strategies, but no cure is available.
Since the very beginning of the HIV/AIDS epidemic, many patients have turned to complementary and integrative medicine (CIM) to treat or prevent complications of their diagnosis.
According to the NIH National Center for Complementary and Integrative Health (NCCIH), more than 30% of American adults use health care approaches that fall outside the scope of mainstream Western medicine.
Of these approaches, the most commonly used are “natural products,” which include botanicals, vitamins and minerals, and probiotics.
But are these products safe? And are they effective? Adriana Andrade, MD, MPH, FACP is an Associate Professor of Medicine at Johns Hopkins University, and she is currently working on two studies investigating the use of two natural products for individuals with HIV/AIDS.
“Dietary supplements are often perceived as natural and thus, safe and not FDA-approved ‘drugs’ because they often derive from botanicals/herbals,” Dr. Andrade explains. “However, natural does not necessarily mean safe and/or lacking pharmacological effect.
In fact, studies have shown that some herbals/botanicals can significantly lower the levels of antiretroviral drugs and potentially lead to treatment failure. In addition, some of these agents can also cause clinically important toxicity.”
Dr. Andrade’s first study looks at American ginseng and the role it might play in lessening HIV-associated fatigue. This study was sponsored by NCCIH and is a collaboration between several Hopkins investigators, including Drs.
Todd Brown, Craig Hendrix and Adrian Dobs, as well as collaborators from the Mayo Clinic and University of Chicago. The CFAR supported the ginseng study by helping Dr.
Andrade and the study team identify potential participants, most of whom live here in Baltimore and receive care at the Moore Clinic.
The second study, funded by the AIDS Clinical Trials Group, aims to address the inflammatory response that seems to be worsened by replacement of “good bacteria” by “bad bacteria” in the gut microbiome, triggered by HIV infection.
Since probiotics contain “good bacteria,” the study team is investigating whether supplementing the diet with probiotic products can restore the balance of bacteria, potentially reducing inflammation that can come with AIDS-associated chronic conditions.
Dr. Andrade stresses that patients should exercise caution and consult their health care providers before taking any dietary supplement.
As she explains, “These agents do not receive the same type of FDA regulatory oversight as traditional drugs. Therefore, there is limited information about their potential for drug interactions, safety and efficacy.
” Continued research, the studies Dr. Andrade is working on, is needed to help fill this information gap.
Dr. Adriana Andrade is an associate professor of medicine at the Johns Hopkins University School of Medicine. Her areas of clinical expertise include HIV/AIDS and infectious disease.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease. A report on the findings was published in August in EClinicalMedicine.
“In South Africa and in many other areas of the world, one of the major reasons HIV is spreading is because young men in particular are not virally suppressed, not taking their medication or are unaware of their diagnosis,” says Bhakti Hansoti, M. B. Ch. B , Ph.D. M.P.H.
, , associate professor of emergency medicine at the Johns Hopkins University School of Medicine and lead author of the research paper.
She adds that young men are more ly to go to an ED for trauma or violence-related injuries than other clinical settings, and may not have a primary health care provider — making the ED the only point of entry for health care in general.
Building on a 2018 study of ED patients in South Africa that found that HIV testing in emergency departments is an effective way to identify and diagnose otherwise hard-to-reach people with HIV, the Johns Hopkins Medicine investigators worked with colleagues in three hospital EDs in East London, Mthatha and Port Elizabeth in the Eastern Cape province of South Africa, the country with the world's largest number of recorded HIV infections.
Nearly 38 million people around the world are currently living with HIV, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). About 20% of people who have HIV live in South Africa.
To end the HIV/AIDS epidemic, UNAIDS established treatment targets for 90% of all people with HIV around the world to know their HIV status by 2020, for 90% of those diagnosed to be on HIV treatment known as antiretroviral therapy (ART), and for 90% of all people receiving ART to have undetectable HIV levels in their blood and, therefore, be unable to transmit the virus to others.
“We already know that HIV testing in the ED is critical to achieving these targets, but testing alone is just not going to cut it,” says Hansoti.
“Testing alone will help us reach that first 90% goal, but to get to the second and third 90%, we believe EDs need to play an active role in treatment initiation.
” EDs also must initiate follow-up case management and link patients to care outside of the ED, the researchers say.
For the new study, conducted between June 2017 and July 2018, the researchers tested 2,901 male and female patients between the ages of 18 and 70 for HIV in the three EDs. More than 800 (28%) tested HIV positive, of whom 234 (28.
9%) were newly diagnosed. The prevalence of HIV in the ED-tested population was significantly higher in women (35.3%) compared to men (20.
7%) — with women ages 36-45 having the highest prevalence (almost 65%) compared with other age groups.
Of all the HIV patients tested for ART, only 54% tested positive for the presence of ART, and 49% of those on ART were found to be virally suppressed. This is significantly below the 90-90-90 targets.
While women were more ly to have HIV, the researchers found that men were twice as ly to be unaware of their HIV status and, therefore, also less ly to be on ART and virally suppressed — and therefore more infectious to their sex partners.
The researchers consider young men, in particular, to be “drivers of the HIV epidemic” in South Africa.
The researchers say their findings suggest that EDs around the world should not only implement routine HIV testing to find often-missed patients but also train physicians and nurses to start patients on ART and provide post-test counselling.
“Patients can be tested for HIV while waiting in the emergency department and then, if positive, be counseled and offered treatment or, at the least, followed up in a specialized HIV care facility,” Hansoti says.
The research team noted the challenges in implementing HIV care services in the ED, including the high volume of patients, and provider hesitation to start patients on ART due to possible comorbidities and liabilities.
Still, the researchers believe these initiatives are needed to curb the HIV epidemic. “Our research shows there are many patients with HIV in the emergency department who are untreated, undertreated and undiagnosed,” Hansoti says.
The researchers say they also plan to explore HIV care strategies best suited to the ED.
Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.
New Source Of Transplant Organs For Patients With HIV: Others With HIV
Dr. Dorry Segev (right), of Johns Hopkins Medicine, led the team of doctors that transplanted an HIV-positive liver and kidney into two different HIV-positive patients this month.
Johns Hopkins Medicine
When a Connecticut woman who was HIV-positive died earlier this month, her family decided to donate her organs to others who needed them.
Doctors in Maryland announced Wednesday that they performed two landmark, successful surgeries with her kidney and liver — transplanting the organs to HIV-positive patients.
This is a big deal, because there continues to be an overall shortage of organs available for transplant, and people living with HIV have an increased risk of kidney and liver failure. Though HIV-positive organs will only go to recipients who have HIV, the ability to use these organs should help reduce the waiting time for all transplant candidates, HIV-positive or not, physicians say.
Dr. Dorry Segev, a transplant surgeon with the Johns Hopkins University School of Medicine, led the team that performed the surgery, and says that he and colleagues first started talking about doing such a procedure six years ago.
“It occurred to us that there are thousands of patients with HIV in need of kidney transplants, liver transplants, who were waiting on waiting lists and suffered high risks of dying while waiting for these organs,” says Segev. “And at the same time, we were throwing away organs from donors infected with HIV just because they were infected with HIV. These were potentially perfectly good organs for these patients.”
But back in 1988, a law had made it illegal for people with HIV to donate organs when they died.
“At that time, in the 1980s, this made sense,” Segev says, “because HIV/AIDS was deadly disease.” And medical accidents with HIV had made transplant teams skittish.
“The virus had been transmitted inadvertently in quite a number of patients with solid-organ transplants,” says Dr. Peter Stock, a transplant surgeon at the University of California, San Francisco.
Stock says there was another reason doctors were reluctant to use the virus-infected organs.
In order for anyone's body to adopt a new heart, liver or kidney as its own, the organ recipient must take certain drugs that suppress the immune system.
But AIDS also suppresses the immune system, and surgeons worried that an organ transplant in someone infected with the virus that causes AIDS might actually do more harm than good.
“It didn't make sense,” Stock says. “We were afraid we would cause rapid progression of HIV to AIDS and death.”
But by the 1990s, better treatment allowed people with HIV to live a lot longer than they used to. And that also meant that a lot more of them needed organ transplants.
In a 2010 study, Stock and other scientists found that transplant recipients with HIV did about as well as recipients who were HIV-negative. By that point, doctors in South Africa — where nearly 20 percent of adults under age 50 have HIV — had started successfully transplanting HIV-positive organs.
In November 2013, President Obama reversed the 1980s legal ban on such transplants in the U.S. — with bipartisan support.
Segev, who led the team that conducted the U.S. surgeries earlier this month, says the time just seemed right to start doing the transplants at Hopkins.
First, his team had to come up with safety protocols and, among other things, get approval from the United Network for Organ Sharing and from an institutional review board to do the procedure.
“It all came together,” Segev says. “So, this was a six-year challenge that involved identifying a problem that affected our patients, doing the research to better understand that problem, taking that to the Hill, getting the bill passed.”
Now he and his colleagues are working to make sure that the two patients who got these organs stay healthy. One is already at home, the other recovering in the hospital. The doctors also are working with 30 other hospitals in the U.S. to get similar surgeries going across the country.
Transplant candidates can still opt to wait for an HIV-negative organ if they prefer, Segev notes.
“We want to make sure,” he says, “that we don't take people who have a relatively nonresistant form [of HIV] and then give them something from a donor who had pretty high-resistance patterns, thereby requiring them to make major changes to their regimen, and maybe even have an HIV that would be less easy to control.”
Because of that concern, the Hopkins transplant team is only accepting HIV-positive organs at this point from people whose virus strains match those of the recipients.
Many people with HIV are expected to opt for the shorter wait period that getting an HIV-positive organ may entail. And that should slightly shorten the wait period for all transplant candidates, Stock says.
“Our waiting lists are off the charts,” he adds. “If you're in the Bay Area and you're waiting for a kidney for specific blood types, you're waiting seven to eight years, so anything we can do to increase the organ supply is so important.”
If all works as planned, Segev estimates this new source of organs might be enough for an additional thousand transplants across the U.S. each year.
“,”author”:”Rae Ellen Bichell”,”date_published”:”2016-03-31T08:21:00.000Z”,”lead_image_url”:”https://media.npr.org/assets/img/2016/03/30/liver-transplant_wide-6a77ef55c676b5b048eac7e47ea743f3cb5de123.jpg?s=1400″,”dek”:null,”next_page_url”:null,”url”:”https://www.npr.org/sections/health-shots/2016/03/31/472389956/new-source-of-transplant-organs-for-patients-with-hiv-others-with-hiv”,”domain”:”www.npr.org”,”excerpt”:”The organ donor and both recipients in the procedure this month were all HIV-positive â a first in the U.S. Using HIV-positive organs for some patients could enable a thousand more transplants a year.”,”word_count”:865,”direction”:”ltr”,”total_pages”:1,”rendered_pages”:1}
Johns Hopkins Performs First Kidney Transplant From Living Donor Who Has HIV
Surgeons in Baltimore have performed what's thought to be the world's first kidney transplant from a living donor with HIV, a milestone for patients with the AIDS virus who need a new organ. If other donors with HIV come forward, it could free up space on the transplant waiting list for everyone.
Nina Martinez of Atlanta traveled to Johns Hopkins University to donate a kidney to an HIV-positive stranger, saying she “wanted to make a difference in somebody else's life” and counter the stigma that too often still surrounds HIV infection.
Many people think “somebody with HIV is supposed to look sick,” Martinez, 35, told The Associated Press before Monday's operation. “It's a powerful statement to show somebody myself who's healthy enough to be a living organ donor.”
Hopkins, which is making the transplant public on Thursday, said both Martinez and the recipient of her kidney, who chose to remain anonymous, are recovering well.
“Here's a disease that in the past was a death sentence and now has been so well controlled that it offers people with that disease an opportunity to save somebody else,” said Dr. Dorry Segev, a Hopkins surgeon who pushed for the HIV Organ Policy Equity, or HOPE, Act that lifted a 25-year U.S. ban on transplants between people with HIV.
There's no count of how many HIV-positive patients are among the 113,000 people on the nation's waiting list for an organ transplant. HIV-positive patients can receive transplants from HIV-negative donors just anyone else.
Only in the last few years, spurred by some pioneering operations in South Africa, have doctors begun transplanting organs from deceased donors with HIV into patients who also have the virus, organs that once would have been thrown away.
Since 2016, 116 such kidney and liver transplants have been performed in the U.S. as part of a research study, according to the United Network for Organ Sharing, or UNOS, which oversees the transplant system.
One question is whether receiving an organ from someone with a different strain of HIV than their own poses any risks, but so far there have been no safety problems, said UNOS chief medical officer Dr.
Hopkins' Segev said Monday's kidney transplant was a world first. Doctors had hesitated to allow people still living with HIV to donate because of concern that their remaining kidney would be at risk of damage from the virus or older medications used to treat it.
But newer anti-HIV medications are safer and more effective, Segev said. His team recently studied the kidney health of 40,000 HIV-positive people and concluded that those with well-controlled HIV and no other kidney-harming ailments high blood pressure should face the same risks from living donation as someone without HIV.
“There are potentially tens of thousands of people living with HIV right now who could be living kidney donors,” said Segev, who has advised some other hospitals considering the approach.
Generally, kidneys from living donors last longer, added Dr. Niraj Desai, the Hopkins surgeon caring for the recipient. And if more people living with HIV wind up donating, it helps more than HIV-positive patients who need a kidney.
“That's one less person waiting for a limited resource,” Desai said. “That helps everybody on the list.”
Martinez, a public health consultant, became interested in living donation even before HIV-to-HIV transplants began. Then last summer she learned that an HIV-positive friend needed a transplant, and tracked down Segev to ask if she could donate.
Her friend died before Martinez finished the required health tests but she decided to honor him by donating to someone she didn't know.
A runner who plans on making this fall's Marine Corps Marathon, “I knew I was probably just as healthy as someone not living with HIV who was being evaluated as a kidney donor,” Martinez said. “I've never been surer of anything.”
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.