Transplants Give Life to HIV-Infected

Not long ago, the thought of transplanting organs into HIV-positive patients would have defied all reason. Giving scarce organs to patients who did not have long to live was considered wasteful, even unethical. Yet like so many things about AIDS, that view is slowly giving way to another: "Now, the question is whether we can ethically exclude these patients," said Dr. Stephen T. Bartlett, a surgeon at the University of Maryland Medical Center who performed a kidney transplant on an HIV-positive patient last month.

The unofficial moratorium on transplants for HIV-infected patients, in force since the 1980s, is slowly being lifted as hospital after hospital has found ways to push boundaries once thought inviolable.

The argument for performing organ transplants on such patients was strengthened by a study presented this year by researchers at the University of California-San Francisco. Among 23 patients who had at least a year of follow-up after their transplants, the survival rate was about 85 percent. Outcomes overall were no different than one would expect among people without the virus.

The University of Maryland Medical Center has recruited patients for a nationwide trial in which 75 HIV-infected patients would receive kidney or liver transplants. One purpose of the clinical trial is to determine which anti-rejection drugs and which antivirals should be used and in what doses. Many doctors believe that certain anti-rejection drugs do nothing to worsen HIV infection while others should be avoided.

Dr. John Conte, who heads the heart transplant program at Johns Hopkins University, said heart transplants for people with HIV remain risky and should be done only by institutions participating in a clinical trial. For now, he said, the Hopkins program is staying out of trials, preferring to reserve the procedure for patients who stand the best chance of succeeding.

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