Hope for HIV/Aids patients with kidney disease

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HIV-positive people with renal failure who get a donated kidney from another person with HIV/Aids fare as well as patients who get one from an uninfected donor, according to a South African study. The work shows that the procedure is safe and effective up to five years down the line, reports Business Day.

It was important because it opened up a new pool of desperately needed kidney donors for HIV/Aids patients, who are especially vulnerable to renal failure, said the study’s lead author, Elmi Muller, who pioneered such “positive to positive” renal transplants in 2008.

Studies estimate that between a quarter and a fifth of HIV-positive patients who do not receive timely treatment get chronic kidney disease. There were 1,204 patients on the waiting list for a kidney transplant in 2013 in South Africa, yet only 204 transplants took place, according to the Organ Donor Foundation. At least 50 HIV-positive patients are on the waiting list for a kidney transplant, said Muller, who is head of the Groote Schuur Hospital transplant unit and president of the Southern African Transplantation Society.

The study also answers questions about the long-term safety of “positive to positive” renal transplants, following the pioneering work of Muller, who did the first such operations in 2008.

Muller and her team tracked the progress of 27 HIV/Aids patients for three to five years. They monitored them for possible “super-infection” from a second strain of HIV, and scrutinised the effect of the immune system-suppressing drugs – needed to protect them from organ rejection – on the progression of their HIV infection. They found their patients had comparable survival rates to patients who had received kidneys from donors who were HIV-negative. The survival rate among the patients was 84% after one year, 84% after three years, and 74% after five years. All the recipients were on HIV/Aids treatment and had no detectable increase in viral load after their transplants, said Muller.

The report notes while kidney dialysis is provided in the state sector, resources are constrained and it is tightly rationed. Kidney patients who have other illnesses such as cardiovascular disease or HIV/Aids are usually denied dialysis and sent home to die.

A kidney transplant can save more than one life, as the recipient frees up a dialysis machine for someone else. Kidney transplants were generally considered more cost-effective than dialysis, provided the patient lived for at least a year, said Muller. Kidney transplant recipients generally lived between 10 and 15 years longer than patients on dialysis.

Researchers had no plans to investigate the scope for HIV-positive people to donate organs to patients who were HIV-negative, said Muller.

The findings have wider implications, says Dr Julie Ingelfinger, deputy editor of The New England Journal of Medicine, and Dr Eric Rubin, of Harvard School of Public Health. Med Page Today reports that in an accompanying editorial, they note that the HIV Organ Policy Equity (HOPE) Act, signed into law in the US in November 2013, permits such transplants and related research. “Although assiduous monitoring remains important,” they conclude, “these transplantations now appear to be not only feasible but also, in fact, desirable for many patients.”

Full Business Day report
The New England Journal of Medicine article summary
Full Med Page Today report
The New England Journal of Medicine editorial summary

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