Man with HIV Gets New Liver

In the most high-profile case to date of an HIV-positive patient receiving an organ transplant, author and activist Larry Kramer underwent liver transplant surgery on Friday at the University of Pittsburgh Medical Center (UPMC). On Monday, Kramer, 66, was listed in serious condition -- typical for transplant patients so soon after surgery. He was expected to be released from the intensive care unit on Wednesday. After gaining recognition as a screenwriter and novelist in the 1960s and 1970s, Kramer helped found the activist groups Gay Men's Health Crisis and ACT UP in the 1980s.

Jeff Getty, an activist with Survive AIDS in California, said Kramer's post-transplant health could be significant in two ways: It could persuade more hospitals to offer transplants to HIV patients, and it could encourage health plans to cover transplant costs. Historically, HIV patients were not eligible for transplants because they almost always developed AIDS and died. But since the late-1990s introduction of new drugs that helped transform AIDS into more of a chronic disease, UPMC has performed 10 liver transplants on patients with HIV. Eight are still alive, including one who was transplanted in 1997.

Kramer's 12-hour surgery on Friday was performed by a team led by Dr. John Fung, chief of transplant surgery at UPMC. "He's doing very well," said surgeon Dr. Bijan Eghstesad. "The liver is functioning fine. Everything is going in the right direction." Friend and caregiver Rodger McFarlane said Kramer was off a ventilator within 24 hours after surgery and cogent by early Monday.

Kramer needed the transplant to cure liver disease caused by hepatitis B. But to keep the liver, he must take anti-rejection drugs that suppress the immune system, reducing the number of disease-fighting T-cells. As a result, Kramer must also take highly active antiretroviral therapy (HAART) to fight HIV. "In Larry Kramer's case, his HIV has been relatively well controlled without HAART. However, like many HIV patients with viral hepatitis, his liver disease continued to progress in spite of anti-hepatitis medications," Fung said in a statement. "Our experience with liver transplantion for hepatitis B has been excellent, and the use of new anti-hepatitis B medications should prevent the redevelopment of hepatitis B in Mr. Kramer."

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