INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS IN THE PITTSBURGH TRANSPLANT POPULATION. A Study of 583 Donors and 1043 Recipients, 1981–1986

Abstract

We performed a retrospective serologic survey of 583 organ donors and 1043 transplant recipients for antibodies to human immunodeficiency virus type 1 (HIV-1). Two (0.34%) of the 583 donors and 18 (1.7%) of the 1043 recipients had HIV-1 antibodies by enzyme immunoassay and by Western blot. Two of 5 seropositive recipients tested also had blood cultures positive for HIV-1. Seven (0.7%) of the 1043 transplant recipients had antibodies to HIV-1 before transplantation; 2 of these had hemophilia A, and 5 had previous transfusions. Eleven (1.3%) of 860 recipients followed for 45 days or more seroconverted to HIV-1 a mean of 96 days after transplantation. Likely sources of HIV-1 infection for 3 of these 11 recipients included a seropositive organ donor in 1 patient and high-risk blood donors in 2 patients. A definite source of HIV-1 infection was not found for the other 8 recipients, 3 of whom seroconverted to HIV-1 after institution of blood donor screening for HIV-1 antibodies. Seroconversion to HIV-1 was less common in kidney recipients than in liver, heart, or multiple-organ recipients (P less than 0.02). Nine (50%) of the 18 HIV-1 seropositive transplant recipients died a mean of 6 months after transplant surgery, and 9 (50%) are still alive a mean of 43 months after transplantation. AIDS-like illnesses occurred in 3 of the dead and 1 of the living patients and included pneumocystis pneumonia (3 cases), miliary tuberculosis (1 case), and recurrent cytomegalovirus infection (1 case). These data suggest that the course of HIV-1 infection is not more severe in transplant recipients receiving cyclosporine than in other hosts and that, despite screening of blood and organ donors, a small number of transplant recipients will become infected with HIV-1.

Solid-Organ Transplantation in HIV-Infected Patients

“…With regard to the first question -the question of absolute efficacy -transplantation can certainly help HIV-positive patients with end-stage organ disease. [13][14][15][16][17][18][19][20][21][22][23] The second question -concerning relative efficacy -is rarely addressed in the distribution of plentiful resources, but there is a strong moral basis for posing this question when scarce resources are being allocated. 24, 25 We do not ask whether elderly persons should receive antihypertensive therapy, even though the benefits of long-term treatment are greater for younger persons.…”

Human Immunodeficiency Virus Transmission

“…Dean et al (1988) and Mundy et al (1987) reported none or low level of pathogens in urine, sweat, breast milk, branchoalvolar lavage fluid, amniotic fluid, synovial fluid, faeces and tears which were not thought to be important source in virus transmission (Fujikawa et al, 1985), but this assumption has also changed with the report of Groopman and Greenspan (1996); Amory et al (1992); Scarlatti (1996); van da Perre et al (1991). Though not a natural source of HIV transmission, cerebrospinal fluid (CSF) in neurologic patients have been shown to contain large amount of virus when compared to other body fluids (Hollander and Levy, 1987;Ho et al, 1989).…”

“…Prior to 1985 (PPHS/MMWR, 1985;MMWR, 1985), when screening of blood, organ and tissue donors for HIV-1 antibody became available, several reports have documented the transmission of HIV-1 by transplantation of kidney (MMWR, 1987;Kumar et al, 1987;Erice et al, 1991;Schwartz et al, 1987;Prompt et al, 1985;L'age-Stehr et al, 1985;Neumayer et al, 1987;Quarto et al, 1989;Carbone et al, 1988), liver (MMWR, 1987;Kumar et al, 1987;Erice et al, 1991;Schwartz et al, 1987;Prompt et al, 1985;L'age-Stehr et al, 1985;Neumayer et al, 1987;Quarto et al, 1989;Carbone et al, 1988;Samuel et al, 1988), heart (Erice et al, 1991;Dummer et al, 1989), pancreas (Erice et al, 1991), bone (MMWR, 1988a) and possibly skin (Clarke, 1987) and In most cases involving donors whose serum had not been tested for HIV-1 antibody (MMWR, 1987;Kumar et al, 1987;Erice et al, 1991;Schwartz et al, 1987;Prompt et al, 1985;L'age-Stehr et al, 1985;Neumayer et al, 1987;Quarto et al, 1989;Carbone et al, 1988;Samuel et al, 1988;Dummer et al, 1989;MMWR, 1988a;Clarke, 1987). As proposed by Simonds et al (1992), approaches to prevention could include: the screening of prospective donors and laboratory markers for HIV1 infection (MMWR, 1985); the inactivation...…”

Liver transplantation in HIV-positive patients: the position of the Brazilian groups

“…The main concern was the potential adverse effects of immunosuppressive drugs on HIV disease progression, in a disease characterized by progressive immunocompromise. Indeed, before the introduction of treatments using a combination of antiretrovirals, commonly known as highly active antiretroviral therapy (HAART) in the management of HIV-infected patients, the results of organ transplants in these patients -either infected during the procedure or knowingly carriers of HIV before transplantation -were poor, most of them having progressed to death due to complications associated with the acquired immunodeficiency syndrome (AIDS) (7,8,38) .…”