Combo HIV therapy may make transplants viable. (Safety, Efficacy Trial Underway).

Organ transplants are becoming an option for patients infected with HIV.

Until recently, infection with HIV was widely considered an absolute contraindication for organ transplantation, but change came with the advent of potent, combination antiretroviral therapy.

"In 1997, the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases was ready to rule that HIV was a contraindication for transplantation. However, results of the combination HIV therapies coming out at that caring time suggested that these drugs could markedly pro-long survival. Based on this, we began to revisit transplants into HIV patients," said Dr. John J. Fung, chief of the division of transplant surgery at the University of Pittsburgh. "Over the past 2-3 years, the results from a few centers are encouraging enough that there is greater acceptance.

By September 2002, 53 patients infected with HIV had received liver or kidney transplants at a handful of centers in the United States, said Dr. Michelle Roland, an internal medicine physician who specializes in HIV care at San Francisco General Hospital. With a median follow-up of slightly less than 1 year, six of the patients had died and organ rejections had occurred in about 38% of the kidney recipients and about 21% of the liver recipients.

"In a small series of patients with short-term follow-up, we see patient-survival and graft-survival rates that are about the same as in patients not infected with HIV." Dr. Roland said in an interview with this newspaper.

These promising results have led transplant teams at the University of California, San Francisco; the University of Pittsburgh; and 11 other centers to start a prospective trial to more fully assess the safety and efficacy of organ transplants in patients infected with HIV. The trial, which may eventually expand to 16 centers, is designed to enroll 275 HIV-infected patients who will be followed for 5 years. Their outcomes will be assessed in comparison with age- and gender-matched patients not infected with HIV who receive transplant organs at the same institutions. The HIV-infected patients who receive cadaveric organs will get them through the waiting lists of the United Network for Organ Sharing, just like any other potential transplant recipients.

But until results are in from this study, some transplant surgeons will remain skeptical of the practice.