Washington, Sept 16: A new report has summarised new developments in organ transplantation for patients with HIV.

Modern treatments—especially the anti-HIV drug combinations known as highly active antiretroviral therapy (HAART)—have greatly decreased the risk of death from AIDS and other causes in patients with HIV.

However, as they live longer, patients risk getting afflicted with other HIV-related complications, including kidney and liver disease related to hepatitis B and C infection. The HAART drugs can also have toxic effects on the liver, compounding the damage caused by hepatitis.

"The blanket exclusion of HIV infected patients can no longer be justified based on the early results demonstrating the safety and efficacy of transplantation in this group of patients," said Drs. Peter G. Stock and Michelle E. Roland of University of California, San Francisco, UCSF, in their study.

Drs. Stock and Roland cited progress in several key areas—including the ability to control HIV infection using HAART and improved measures to prevent opportunistic infections—that have made organ transplantation an increasingly viable option for HIV-positive patients.

Studies performed in the "post-HAART" era at UCSF and elsewhere have shown promising results. In one study of liver transplantation in HIV-positive patients, the 3-year survival rate was found to be 73 percent—similar to that of HIV-negative patients.

“At transplant centres worldwide, criteria for considering transplantation in HIV-positive patients are slowly being liberalized. In most cases, patients must have "undetectable" HIV levels before kidney transplantation can be considered. Exceptions may be made for patients with liver damage related to HAART drugs,” the authors wrote in their study.

“At first it was thought that, because of their weakened immune systems, HIV-positive patients would need less immuno-suppressant therapy to prevent transplant rejection. However, early experience has suggested that rejection rates may be higher in HIV-positive patients, especially early after kidney transplantation. There is also evidence that some of the immuno-suppressant drugs given after transplantation also have antiretroviral (anti-HIV) effects,” the study said.

The researchers have, however, said that more research would be needed to understand the complex interactions between HAART and immuno-suppressant drugs, and to develop specific immuno-suppressant strategies for HIV-positive patients.

So far, there is no evidence that the risk of progression to AIDS is increased after organ transplantation, they said.

“Further progress is needed in these and other key areas. Meanwhile, the concept of organ transplantation for HIV-positive patients is increasingly accepted by insurers and policymakers in the United States and elsewhere,” the researchers said.

"It is imperative that HIV-positive patients, HIV health care providers, and the transplant community are aware that transplant is a viable option for the HIV infected patient," they added.

The study is published in the September 15, 2007 issue of Transplantation, the official journal of The Transplantation Society. (With Inputs from ANI)