People with HIV Reaching Top of Transplant Lists

Because the overall health of a patient is among selection factors, fewer than 40 HIV-positive patients have received life-saving liver transplants -- even though many gay men with HIV are infected with hepatitis B. But with antiviral drug combinations prolonging the lives and improving the health of those with HIV, more people with HIV are finding themselves on the waiting list for a liver.

Hepatitis B, like HIV, often lies dormant for years and then relapses into life-threatening liver disease. Two studies this year suggested that such relapses might be associated with protease inhibitor combinations; a study last year linked relapse to discontinuing the nucleoside 3TC. Also like HIV, hepatitis B can be transmitted through bodily fluids during sex, making co-infection "relatively common," says the National Institute of Allergy and Infectious Diseases. Hepatitis B both weakens the patient and triggers replication of HIV.

To be put on the list for a liver, which is maintained by the United Network for Organ Sharing (UNOS), a patient must be evaluated by a hospital that performs liver transplants. Moving to the top of the list is reserved for patients with "sudden liver failure that leaves them with a life expectancy of fewer than seven days," according to UNOS policy, which is up for revision this year. It also suggests that a patient with HIV and without HIV symptoms "should not necessarily be excluded from candidacy for organ transplantation." UNOS requires HIV screening of all potential recipients. Since 1988, only 37 liver transplants have been performed on people with HIV. The 11 of those performed last year represented less than 1 percent of the 4,955 liver transplants carried out in 2000.

Activist Larry Kramer, who has AIDS and hepatitis and needs a liver transplant, described the many obstacles facing those needing the procedure. People seeking a transplant often affiliate themselves with hospitals in several cities, each of which typically requires a battery of expensive tests and may demand a deposit of up to $500,000. Kramer, who is on the list to receive a liver at the University of Pittsburgh Medical Center, described navigating the complex system as "like dealing in a foreign language and a foreign country."

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