In South Africa, someone is diagnosed with blood cancer every 72 minutes – but because of the lack of bone marrow transplant donors, scientists are now urging and devising solutions to include HIV-exposed or infected stem cell donors as donors.
There are 8m people with HIV in SA, all of whom are excluded as donors for bone marrow transplantation, according to the Institute for Cellular and Molecular Medicine at the University of Pretoria, in a recently published study in The Lancet HIV.
One of the authors, Dr Candice Hendricks, a paediatric haematologist and PhD candidate in medical immunology, said they were creating solutions by challenging the norm of excluding HIV-exposed or infected stem cell donors.
“The purpose of advocating for this research is that there’s a lack of donors for transplantation and this pool needs to be increased…people with HIV who are well-controlled on their anti-retroviral medication could potentially donate their stem cells to friends or family for whom they are a match for transplantation.”
Hendricks said using blood stem cells from people with HIV came with the potential risk of the recipient contracting the virus from the donor, and other possible complications.
“People with HIV are, however, eligible to be recipients of a bone marrow transplantation if they meet the normal criteria for transplantation," she said.
News24 reports that according to the study, the number of patients undergoing haematopoietic stem-cell transplantation (HSCT) was far below the target.
“Donor numbers are insufficient to meet the demand,” wrote the authors. “Both HSCT and solid organ transplantation have succeeded in people with HIV. This personal view explores the possible inclusion of people living with HIV and umbilical cord blood from HIV-negative infants exposed to HIV as donor sources for HSCT.”
The study also noted that in an HIV-endemic country, people with HIV or donors exposed to HIV must be considered as part of a multidisciplinary collaborative effort to provide the opportunity to have a life-saving HSCT.
HIV and human rights activist Zola Tshayana said he knew of only one person with HIV who had undergone a bone marrow transplant in South Africa.
“The cost of bone marrow transplants is a hindrance, too. I agree there must be an expedited investigation into the safety or risk of HIV-positive donors. Still … there must be a drive to educate the public, especially the black populace, about being organ and stem cell donors,” he said.
He added that based on media reports, there was a handful of cases worldwide of people with HIV who were cured after the transplant.
He said people were spending a lot of money travelling to various countries because of the hype around stem cell therapy.
“Most of them don’t come back with results, and we need to investigate this and be open and honest about it.”
Study details
Haematopoietic stem-cell transplantation in an HIV endemic area: time to consider donors exposed to or living with HIV
Candice Hendricks, Juanita Mellet, Chrisna Durandt, David Brittain, Michael Sean Pepper.
Published in The Lancet HIV on 11 October 2023
Summary
South Africa has more than 8m people living with HIV. However, the number of patients undergoing haematopoietic stem-cell transplantation (HSCT) in South Africa is far below the target number. Donor numbers are insufficient to meet demand. Both HSCT and solid organ transplantation have proved successful in people living with HIV. Solid organ transplantation also has good outcomes when both donors and recipients have HIV. This Personal View explores the possible inclusion of people living with HIV and umbilical cord blood from HIV-negative infants exposed to HIV as donor sources for HSCT. Beyond the risk of HIV transmission, additional complications must be considered, such as delayed or inadequate immune reconstitution and an increased risk of haematological abnormalities and malignancies. Interactions between antiretroviral drugs and drugs used in the conditioning regimen, as well as the need to maintain virological suppression when gastrointestinal absorption deteriorates, are additional complicating factors. The process also requires more stringent ethical processes to be in place to minimise physical and emotional harm. However, in an HIV endemic country, people living with HIV or donors exposed to HIV must be considered as part of a multidisciplinary collaborative effort to provide more patients with the opportunity to have a life-saving HSCT.
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Bone Marrow Registry: SA second country to allow donations from 16-year olds