Organ transplantation is a safe treatment option for patients with human immunodeficiency virus (HIV) infection who need the operation, conclude researchers who reported their findings at the International Congress of the Transplantation Society. More important, they add, the immunosuppressive drugs used to control organ rejection seem to have little effect on HIV progression.
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The advent of new treatments, such as highly active antiretroviral therapies (HAARTs), has meant that HIV patients who have liver disease are living longer— and thus are at risk for end-stage liver failure as a result of the infection or as a result of nephrotoxic drugs. The challenge, the researchers say, lies in finding the right balance between the antirejection drugs and the antiretroviral therapies. Oversuppression of the immune system might allow the HIV infection to worsen, but too low a dose puts the patient at risk for organ rejection.
Researchers at Hahnemann University Hospital in Philadelphia reported that 17 of 20 kidney transplant patients with HIV infection are alive one year after their study, with a very low to undetectable viral load. In one of the 20 patients, graft rejection developed because of an interaction with HAARTs.
In a French study, presented by a researcher from Paul Brousse Hospital in Villejuif, six patients with HIV infection and hepatitis C underwent liver transplantation. One died of liver failure, but the rest are alive more than a year later, with negligible levels of HIV viral load. However, interactions between the antirejection drug tacrolimus and protease inhibitors caused an acute rejection in one patient and toxic levels of tacrolimus in another.
In a study of seven liver and four kidney transplant patients at the University of Pittsburgh, the researchers observed profound drug interactions between tacrolimus and HAART that included a protease inhibitor. In contrast, regimens that included nucleoside reverse tran-scriptase inhibitors or non-nucleoside reverse transcriptase inhibitors resulted in less significant effects.
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A study conducted at the University of California, San Francisco, found that viral loads have remained undetectable in four liver and 10 kidney transplant recipients. One patient died as a result of a rapid recurrence of the hepatitis virus. The researchers reported no evidence of significant HIV progression and no adverse effects of the virus on organ function.